Public support for the NHS’s founding principles – that it is free to use, available to everyone and tax-funded – has fallen over the last five years, research has shown. Backing for all three pillars dropped between 2021 and 2025 across the UK population, except for a small rise in millennials’ support for the NHS being funded from taxation. Experts said the sharp rise in economic hardship and changes in attitudes towards migration during those years could help explain the drop in support.
With healthcare swallowing up ever more public spending as the UK contends with an ageing population, and the government is under pressure to spend more on defence, social care and the special educational needs system, that decline could make it harder for ministers in future to justify raising the NHS budget. The King’s Fund thinktank analysed British Social Attitudes survey data on attitudes towards the NHS’s founding principles among five age groups: gen Z (born 1997-2012), millennials (1981-1996), gen X (1965-1980), boomers (1946-1964) and those born prewar. Support for the NHS being free of charge and available to everyone has fallen in recent years across all five groups.
While large majorities still agree that it should be available to everyone, the decline in that belief was particularly striking. The proportion of those born before the second world war who think that declined from 87.1% in 2021 to 73.2% last year – a 13.9 percentage point fall. Among boomers it fell from 83.1% to 71.2% – down by 11.9 percentage points.
Support for the NHS being free of charge was also down, but by smaller proportions, and it remains a belief shared by between 85% and 92% of the population. However, the analysis also revealed the emergence of what the King’s Fund called “a generational fault line in attitudes to NHS funding”, with gen Z holding different views from other age groups. Support among gen Z for the NHS remaining tax-funded fell by 11.2 percentage points from 2021-2025 – a bigger drop than among gen X, boomers and the prewar cohort.
Fewer than four out of five gen Z (74.1%) hold that belief, compared with at least 80% elsewhere. Danielle Jefferies, a senior analyst at the King’s Fund, said that public backing for the NHS’s underlying principles remained strong 76 years after its creation. Our analysis shows a slight fall in support for the founding principles of the NHS over the last five years, against a backdrop of record low public satisfaction with the NHS and growing divisions across different age groups and political perspectives.
While there is no single explanation for the recent shift, wider changes in public attitudes may be playing a role. Analysis from the Institute for Fiscal Studies suggests that younger adults today are economically worse off than previous generations at the same age. They face high housing costs, significant student debt, years of wage stagnation, and were the first generation to come of age in the aftermath of austerity and during the Covid-19 pandemic.
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