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.
Decline Across All Age Groups
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.
Generational Fault Line Emerges
However, the analysis, conducted with Ipsos, 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.
“Nevertheless, politicians and the public should not take that support for granted. 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.
“The public's longstanding support for the NHS is often wrapped up with the country's identity, so it is hard to unpick exactly why support for the principles might be falling slightly. While there is no single explanation for the recent shift, wider changes in public attitudes may be playing a role.
“For example, the latest British Social Attitudes survey suggests that changing attitudes towards migration may play a role in declining certainty about the principle that the NHS should be available to everyone.”
Economic Pressures on Younger Generations
Economics probably explains Gen Z's attitudes, Jefferies added.
“Gen Z are coming of age in incredibly challenging economic climate. 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.
“Against that backdrop, it's perhaps unsurprising that younger adults are more hesitant about paying higher taxes to fund public services. Add to that that many younger people might be trying to access [NHS] services like mental health support and dealing with long waits, many could feel short-changed,” Jefferies said.
“When living standards have stalled and many are dissatisfied with public services like the NHS, support for paying more tax cannot be taken for granted.”
Long waiting times for NHS care such as A&E, surgery, cancer treatment and mental health help may influence public opinion too.
Ciarán Devane, the chief executive of NHS Alliance, said: “At a time of huge and sustained challenges for the health service, it is natural that people may question the funding model, though it's worth noting that even in generation Z, a large majority backed the current approach.
“That 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.”
