Support for founding NHS principles declines across UK, King's Fund study finds

Public support for the founding principles of the NHS — that it is free to use, available to everyone and funded through taxation — has fallen over the past five years, according to analysis published on Tuesday by the King’s Fund thinktank.

Drawing on British Social Attitudes survey data from 2021 to 2025, the research found backing for all three pillars dropped across nearly every age group, with only millennials showing a small rise in support for tax-based funding.

The decline in commitment to universal access was particularly pronounced among the oldest. The proportion of people born before the Second World War who said the NHS should be available to everyone fell by 13.9 percentage points to 73.2%, while among baby boomers it dropped 11.9 points to 71.2%. Support for care remaining free of charge fell by smaller amounts, with broad agreement of between 85% and 92% across all cohorts.

The King’s Fund said a “generational fault line” had emerged over how the health service is funded: support among Generation Z for the NHS remaining tax-funded fell 11.2 percentage points to 74.1%, compared with at least 80% in every other age group.

Danielle Jefferies, a senior analyst at the thinktank, said public backing for the NHS’s underlying principles remained strong 76 years after its creation but warned that “politicians and the public should not take that support for granted”.

Jefferies said changing attitudes towards migration could help explain the decline in support for universal access, while younger adults — facing high housing costs, significant student debt and wage stagnation, according to the Institute for Fiscal Studies — were more hesitant about paying higher taxes.

Ciarán Devane, the chief executive of NHS Alliance, said: “Any erosion of support is a concern. The NHS must keep delivering for the public and for patients, and making the case for continued public backing, including through their taxes.”