The polling is clear: UK public is finally ready for serious NHS reform

We are all accustomed to the tremors which herald every healthcare crisis in Britain: winter bed shortages, rising waiting lists, the salacious details of yet another scandal. And the political class responds with the common antiphon: “more time, more staff, more money!” All the NHS needs, we are told, is the right spending in the right places and further recruitment of doctors and nurses from abroad; then the congregation is told to sit down and trust in the benevolence of the NHS.

Yet, as new polling from the Prosperity Institute reveals, the faith Brits have in the NHS is on shaky ground. Although people are still devoted to the creed of “free at the point of use”, they do not think the clergy deserve any money in the offering basket. In fact, nearly half of respondents view healthcare as one of the three most important issues facing Britain today; with the economy (66 per cent) and immigration (50 per cent) being the other two – the Holy Trinity of today’s British political discourse.

The findings are glaring: from a pool of 5,000 respondents, the 22 per cent who believe that immigration does not pose a strain on the NHS are dwarfed by the 49 per cent – more than double – who consider immigration as a net burden on the NHS. 59 per cent believe that the government should prioritise NHS reform over further spending and 65 per cent of respondents – including 65 per cent of current Labour voters – believe that British doctors should take precedence over foreign doctors.

What these statistics reveal is that the public is frustrated by the status quo, and is demanding change. For many years, the response to challenges in the NHS has been to throw more money at the problem with the hope that that more funding would somehow fix the issues. At 11 per cent of GDP, public spending on the NHS has increased by 50 per cent since 2012, reaching £187bn currently. Yet waiting lists stay at close to record highs and more people are spending out-of-pocket for private healthcare (£46bn in 2024). It is evident that the current NHS model is untenable; a view held by 45 per cent of respondents.

What this shows is that the old tropes of “the left want to spend, while the right want to cut” does not reflect the ground on which the public is standing. Instead, people see profligate spending, mismanagement and expanding bureaucracy as the major problem. For instance, when asked what they considered to be the major cause of maternity scandals, only a quarter of respondents suggested that they were caused due to funding issues, as opposed to nearly 50 per cent who blame mismanagement issues instead. People are no longer asking how much the NHS needs to function, they are asking: “What are you doing with the money you receive?”

The shift in public perception is illustrated by the intersection of public attitudes to immigration and the NHS, which may prove awkward reading for the political class. The sentiment that immigration is a net burden on the NHS now has broad political consensus amongst Conservative, Reform, Plaid Cymru and SNP respondents – with only Labour and Green respondents largely believing it is a net positive. The common retort that “the NHS would fall apart without foreign workers” is losing its lustre, as over two-thirds of respondents think the NHS should prioritise British doctors over foreign ones (including 65 per cent of Labour respondents and even 42 per cent of the Greens). People also seem to prefer the care provided by British doctors and nurses as 42 per cent say the quality of service is better than what is provided by foreign-trained doctors and nurses. This is not a convenient data point for a political class that always seeks to suggest that any link between high immigration and stretched services is a racist fantasy.

It would be absurd to dismiss this as simply prejudicial. The proportion of NHS staff born abroad has doubled since 2010 (from 11 per cent  to 21 per cent in 2025), indicating the NHS’s reliance on foreign workers is a policy choice. Conversely, funding for training places for home-grown talent has not been sufficient to address the needs of modern NHS service delivery. Juxtapose this with publicised scandals showing sham care visas, non-existent employers and fraudulent qualifications, it is little surprise that the public sees “import more staff” as a losing policy agenda for NHS reform.

Nonetheless, public opinion places significant trust in frontline staff with doctors and surgeons (82 per cent) and nurses (80 per cent) being the most trusted personnel within the service. By contrast, only 31 per cent of respondents express trust in NHS management. This contrast reveals a broader issue: the public believes in the primary precepts of the NHS but do not trust the current management based on their track record.

Considering where best practices can be adopted from, Brits preferred options in countries such as Switzerland, the Netherlands and Germany. These countries all have mixed models where universal access to healthcare sits alongside insurance and independent providers. The US model was broadly rejected, even among Reform voters, with a net rating of -22 per cent. This shows that the public remains committed to universal healthcare access while being open to structural changes that could improve service delivery outcomes.

So, what do voters really want? The top-three answers are: care should be kept free at the point of use, there should be more doctors and nurses and outcomes on survival rates for illnesses such as cancer should improve. Only two per cent of respondents placed the current panic across Westminster that US companies are buying up the NHS as their top concern.

As with most areas of concern these days, public opinion is more hard-headed than policymakers may like. People expressed a relaxed view on a health service open to competition from independent providers as long as universal healthcare was preserved, with 67 per cent saying that hospitals should be given more independence to operate in a way that serves local needs rather than based on a centralised approach from government. Also, nearly two-thirds of respondents stated that they would be open to private healthcare if they could afford it. People expressed concerns with the way A&E is abused (73 per cent) with 66 per cent supporting fining people who miss their appointments.

When asked if politicians “getting a grip” on NHS issues would improve their view of them, 61 per cent of respondents agreed, with nine per cent saying that it would make the issues worse. Worryingly, 52 per cent believe the NHS would cease to exist without structural reform. This shows that the public is aware that the model is not fit for purpose, are open to change and are pleading for clarity from their elected officials.

This is an invitation for the British political right – which bellows its belief in the free market while also pledging to protect “Our NHS” – to practice what it preaches. If the NHS was not constantly on the verge of collapse, people could relate to it once again not as a national religion but as simply an efficient service provider. The ground has shifted. The public is willing to borrow best practice from places that use a mixed model. And they are worn-out by the “immigrants will fix it” mantra.