State of the nation: So, Tony, on a scale of one to ten, how does your government rate?

TONY BLAIR admitted yesterday that it could take 10 years to "turn round" Britain's ailing National Health Service as he pleaded with the voters to give him more time to improve public services.

Unveiling the Government's second annual report on its performance, the Prime Minister said he shared the voters' impatience that it was taking time to deliver its election pledges to cut class sizes and hospital waiting lists.

"No one is more frustrated than me," Mr Blair said. "To turn round a big public service is a ten-year project and it will take time to do it. I understand the frustration that things aren't happening quickly enough for people." He conceded: "There are still things where we have got to improve things and do better." This harsh reality of government was in marked contrast to Labour's 1997 election slogan, "Things can only get better."

Mr Blair insisted the Government was "on track" to deliver its promises. The annual report claimed that, of Labour's 177 manifesto commitments, 90 have been met, 85 are under way and only two have yet to be timetabled.

However, close scrutiny of the list suggests the Government has been more than generous in this exercise. How, for example, can ministers claim to be "on course" to hold a referendum on reforming the voting system for Westminster? The Jenkins Commission report of last October has been kicked into the very long grass, and even Lord Jenkins now admits there is no prospect of a referendum before the general election. Similarly, a promised to hold a referendum on any decision on the single currency membership is classisified as "kept." Yet there will be no referendum until the next Parliament at the earliest.

Another promise classified as "on course" is to protect home-buyers by consulting on ways to beat gazumping. The consultation has happened, but there is little sign of any action.

A commitment to a "free vote on fox-hunting" was technically honoured. But the Government failed to provide Parliamentary time for the backbench bill on which the vote took place. Despite Mr Blair's recent promise of legislation, a decision is likely to be shelved until the autumn.

Other election pledges were hardly exacting. Would Labour really have failed to "back the 2006 World Cup bid?" Only if they had campaigned for it to be held in Germany. Some promises were so vague as to be meaningless. Showing "leadership in the Commonwealth" was "kept" by hosting a successful heads of government meeting in Edinburgh. So that's alright, then. Ministers said the 88-page annual report, which cost pounds 75,000 to produce, was a "candid, honest, factual account" of the Government's successes and failures, after criticism that last year's glossy pounds 96,000 publication was too triumphalist. However, few "warts" in the public services were laid bare in this year's version and Whitehall watchers said the civil servants who drafted the report were hardly likely to criticise the performance of their political masters.

The Government faces pressure to allow an independent audit of its performance and the 600 targets set for Whitehall departments by the Treasury. Critics claim its internal monitoring system is little more than a public relations exercise.

Launching the report at Homerton Hospital in Hackney, London, Mr Blair faced the wrath of an 82-year-old pensioner, Miriam Lewis , who repeatedly interrupted his question and answer session. She urged him to "hurry up" and make a difference to the lives of ordinary people struggling with low pensions and hospital waiting lists.

Mrs Lewis told the Prime Minister: "I get facts and figures from you. But appointments are still taking a long time. " She said people "don't see" the extra money the Government had pumped into the NHS.

The Tories claimed that only one in four of Labour's pledges had been kept. It said 33 had failed, 45 had been fudged and 54 not delivered. Of the 45 done, three quarters were damaging in their effect or were completely pointless.

Andrew Lansley, shadow Cabinet Office Minister, said: "Labour is failing to deliver. Three of out of four children are in rising class sizes. Total waiting lists, including those waiting to see a consultant, have gone up." Nick Harvey, the Liberal Democrats' campaigns chief, said: "The annual report should be subject to independent scrutiny from the National Audit Office and debated by Parliament."

The Government admitted a typographical error in the report, which features a page on how crime in Carmarthen is being cut. The document spells the Welsh town as "Carmarthon" three times.