Public mood and the future of the NHS – with Luke Tryl

King’s Fund and Nuffield Trust (2025). Public satisfaction with the NHS and social care in 2024 (BSA): Results from the British Social Attitudes survey. 

More in Common (2025). Shattered Britain: Making sense of what Britons want in a country that feels broken. 

More in Common (2025). From protest to power? Inside Reform UK’s changing support base. 

Ipsos (2026). Concern about defence doubles to become as big an issue for Britain as the NHS and inflation.  

Jennifer Dixon 

Public surveys show rock solid support for the basic principles of the NHS. That's universal, free at the point of use based on means, not ability to pay. Yet, on the other hand, the British Social Attitudes survey shows increasing dissatisfaction with quote, ‘the way the NHS is run nowadays’, and we've also seen growing use of privately funded care over the last decade, especially since the pandemic. So can we take public support for the NHS model for granted? And given the amount of volatility and polarisation in politics, what might be ahead? 

Well, here to discuss this with me are the chiefs of two of the foremost research agencies into public attitudes. We've got Luke Tryl, the Executive Director of More in Common, and Rachel Wolf, the CEO of Public First. We're going to do this in a two part conversation: Luke this week and Rachel next time. 

So what we're trying to do today, Luke, is to try and understand what the public mood is now, and also try to predict what might happen in the coming short term, maybe the next 5 years. Because we want to understand whether the public support for the National Health Service is going to remain rock solid, given the volatility we've got with politics, given the rage clearly in the public mood. 

So I thought, before we get into the NHS itself, could you paint for us the wider picture. How do you describe the wider public mood in the UK today? 

Luke Tryl 

Well, I'm afraid it's not a particularly positive picture that I'm going to paint for listeners. There are two words that I use to describe how the public are feeling at the moment. One is frustrated. This sense that life is too hard for too many people. There are too many everyday frictions, that things feel too unaffordable and that things feel quite exhausting as well for lots of people. I've described it before as if you were to visualise the British public as one person, it's probably a person in, you know, one of those control rooms you see in sci-fi films, and there's a big red button that says ‘change’ on it, and what keeps happening is the public keep pressing this button and nothing happens. 

So 2016 the Brexit vote is a vote for change. 2017 you get that Corbyn surge, which is a vote for something different. 2019 you get the Boris red wall conversion. Voters who've never voted conservative before come over, they're voting for change. 2024 change is literally on the front of Labour's manifesto. And yet here we are some 18 months in, and people are very definitely frustrated at the pace of change. 

The second one, which is equally important, is discombobulation. This sense that the world feels a lot more uncertain. I have a lot of people saying to me at the moment in focus groups, I'm worried about the world my kids are growing up into. Now, in part, that's related to international affairs, as you can imagine. You know, Trump, Greenland and what's happening in Ukraine and the Middle East, but also closer to home, a growing sense that people feel the government isn't in control of events. Why can't it stop the boats? Why can't it tackle waiting lists? And this sense that we're sort of trapped in this politics of can't, rather than the politics of can, is driving a lot of our politics. 

So I think it's that twin sort of frustration and discombobulation, and, of course, the Mandelson Epstein revelations, you know, add a third dimension, which cuts again across both of them. Which is the sense that the system is rigged. There's one rule for an elite who look out for each other, and another rule for everyone else. 

We know throughout history and across the world that nothing is more likely to turbo charge what you might call populist or anti-mainstream sentiment than that feeling of a rigged system. But I still think that at its heart it's that frustration and discombobulation. 

Jennifer Dixon 

And how far is that targeted on politics and government, and how far is it targeted on institutions, the ones we know and we're very familiar with, particularly, for example, the BBC, the NHS? Institutional or political?

Luke Tryl 

I think it's both. Trust in politics is very low at the moment. And, you know, you sometimes get people saying, oh, but hasn't it always been thus? I think the difference this time is that it's beyond that kind of healthy British cynicism and has morphed into, as I say, as frustration, anger and a sense that politicians maybe just aren't up to it. They can't do the job. But as you say, would be a mistake to think of this as purely limited to politics. It is wider. It extends to the media. It extends to the BBC. Extends to the legal system as well. It extends to business. You know, very few big institutions are escaping this crisis of trust. 

I should, perhaps, given I've painted a rather gloomy picture point out that there are two bright spots of reassurance amongst the British public. One is we have very high trust in scientists in this country, and that interestingly extends across all of our segments, even the ones that are quite anti system and sometimes come in a bit more conspiracy minded, and also high trust in people's neighbours. That horizontal trust is still there. I mean, you know, it faces phrase and fractures, but is still stronger than that vertical trust when it comes to the NHS, particularly the people in it. They have high trust. And crucially, I often say that, you know, we shouldn't just look at trust. We should look at whether people feel respected by an institution as well. People tend to say that those working in the NHS respect them. So a bit of a mixed picture, but very definitely a mistake to assume that our problems, or the problems of trust and legitimacy are limited to politics. 

Jennifer Dixon 

Now you had a very interesting report, which I urge listeners to read, which was published last July, and it's called Shattered Britain. And there you segment the population into seven, don't you? What was quite interesting with these particular segments is there are certain segments that are leaning towards these challenger parties that we're seeing great support for. And we'll get on to what those parties are saying about the National Health Service in a minute. But could you just talk us through these segments and how they crystallise, consolidate into certain parties at the moment?

Luke Tryl 

Yeah, absolutely. So, just zooming out a little bit, having talked about those very clear challenges or frustrations in the public mood, what they in turn, lead to is a series of fault lines in terms of how we get out of the mess, or the malaise, or whatever you want to call it. If we accept broadly that most people think that the UK is not in a great place right now, and we need to improve it, what do we do to get out of that?

And I think the most interesting divide now in our politics is, is not left, right or, you know, on economic issues or socially liberal, socially conservative. The axis that I think is most interesting is those who say, we can sort Britain out by preserving and improving our existing institutions, or, and this is the exact poll wording we use, ‘When I think about our political and social institutions, I cannot help but feel just let them all burn.’ 

Broadly, 60% of people are in preserve and improve and 40% are in the ‘burn it all down’ and go on, to talk about how that maps into the various challenger parties, but that's one of the things which we use to create this segmentation, which is essentially the seven groups or seven tribes of Britain, and it extends from groups. So on the left, we have progressive activists. They are a very socially liberal, very engaged left leaning on economics as well. Kind of dominate NGO world civil society, want to do good, but can very often be outliers on questions around national identity. So the only segment that, for instance, say they feel bad when they see the Union Jack flying. They are driving the surge in support for the Green Party. You've then got a group called the incrementalist left, who actually share lots of the starting points of progressive activists in terms of wanting a fairer society, but they're just much less political and seem more good in the status quo. They often describe themselves as ‘news avoiders’, and, they don't like looking at what is going on in the world. Dislike conflict. And established liberals, who you might think of as sort of camera night conservatives, or blue wall adjacent, you know, they're quite economically right, leaning more socially liberal, quite outward looking, they're techno-optimists as well. And you've got sceptical scrollers, who are an interesting group, younger group, very much shaped by the pandemic. And as the name suggests, you know, a lot of their lives are mediated through online platforms as well, quite low trust. Tend to think the social contract is broken. And they are the group most likely in focus groups, when I chat to them to say things like, I like to find my own truth. You then got rooted patriots who are your sort of red wall-y group. Pride in the country, very rooted, as the name suggests, in their communities, tend to feel overlooked by the Westminster system, as you might call it, swung quite significantly behind Boris Johnson but also quite risk averse as well, had quite high threat perception. You then got traditional conservatives, as the name suggests, most conservative segment. I think Boris Johnson took 85% of the vote with this group in 2019 interestingly, now Tories are tied with reform amongst them, which speaks to their difficulties. They're a group who nostalgic, believe in preserving the status quo, but quite institutionalist as well, as a result. And then the final group, the dissenting disruptors. If rooted patriots feel overlooked by elites, dissenting disruptors tend to feel actively disparaged. They see much more merit in burn it all down, thinking more attracted strong man leadership, quite uncomfortable with elements of multicultural Britain, and they're the only group that reform won at the last election, and they are really powering their gains.

Jennifer Dixon 

And just roughly how big is that group as a share? 

Luke Tryl 

So that's about 20%. 

Jennifer Dixon 

20% but you said earlier that 40% was, were kind of let it burn… 

Luke Tryl 

Yes. So some progressive activists are let it burn, right? Because they are, you know, from from the other end of the spectrum, they are like, you know, the rigged system, and you know, the structures of describe it quite like, almost there wouldn't be your structures of capitalism aren't working. 

They're about 12% and then, yeah, there are some across the other groups who have that mentality. But it's the dissenting disruptors who have it most. And within the dissenting disruptor group, it's very definitely not all of them. It's probably it's probably about a quarter of the 20% there is a group who do just have fundamentally anti-democratic values. Now, you know the group who said that violence was justified in the riots outside asylum hotels, but the other you know 15% people who are just deeply unhappy with the status quo.

Jennifer Dixon 

You were saying that a lot of the dissenting disruptors are attracted to Reform, but presumably, as Reform’s popularity increases, they are moving further into the centre. Is that correct reading? So they could be becoming more moderate Reform UK, from their initial sort of rage burn it down group. 

Luke Tryl 

Oh, absolutely. And, you know, a couple of things to say on that. One is yes, from a segment lens, the gains since the election have been moving into, as I say, tying the Conservatives amongst traditional conservatives, but also crucially for them, because it's another 20% making gains among that rooted patriot group. And that is the group who is quite interesting when they think about reform, because sort of on what I call the Reform seesaw, which is at the one end, they will go, oh, you know, some of the things reforms, doing it too risky. You know, they might be too extreme. Will it be like Donald Trump, who's not popular in the UK at all, but on the other end of the seesaw, you've got, gosh, things just feel so bad, I may as well roll the dice. And we've given the Tories a shot. We give Labour a shot. And actually, this week, I spoke to a woman who was very much in that group, who said, Luke, the thing is, I think where I've got to is I'm scared that I'm going to end up voting Reform, which is such an interesting way of conceptualising it. And I think what a lot of the media have missed, and I think the political parties are missing. Them is that reforms second 15% that is that 15% they've gained in the polls since the election looks quite different to the sort of diehards who voted for one hand as the person I was talking about was a woman. They're much more female Reform’s newer voters, but Reform’s, gender split is now more female than the Labour party's, which is pretty extraordinary, but they tend to be more moderate. 

They tend to agree with on immigration, but they tend to be less sceptical on issues like climate change, for instance. So part of the challenge for reform, if you go back to that seesaw, is, how do they make sure that those naturally more risk averse voters don't think that this is going to be Donald Trump 2.0? We've seen from enough elections around the world to know that Donald Trump's influence on elections does not stop at the US borders. You know, if you look at Canada, if you look at Australia, if you look at what's happened at the polls in Denmark, a rally around the government or flag effect that Trump can create up ends domestic politics in other countries too.

Jennifer Dixon 

Also, I suppose, if you're Reform UK, how do you maintain your energy if you have a bigger influx of, quote, ‘normal voters’, as you describe them in one of your reports? In other words, the sort of insurgency, the narrative of rage, is somehow diluted, and with it, their insurgent energy is diluted.

Luke Tryl 

Yeah, exactly. No, no, exactly that. I think it is a really good encapsulation of the challenge that reform UK face, part of the reason they have sort of broken through is because they've been willing to say the things which, you know others might not, that people say if Nigel Farage doesn't look like a typical politician, but if you're going to be taken seriously beyond your core base of support, A, you need to have a wider policy platform. B, you need to be much more reassuring. You need to be willing to compromise and much more as well. So it is very different, you know, and we have said before and described it as, you know, it's 'Nigel Farage's choice', does he want to have a very energised, quite purist base of support, but it would be difficult for them to reach power? Or do they want to make the compromises, even if some of their base are uncomfortable with those compromises? And I think, look, everything we've seen so far, you know, some of the shift on economic issues that we've seen from Reform on the NHS. You know, being very clear that free at the point of use isn't negotiable from their point of view. I think we are seeing them making those compromises, but, you know, it remains an Achilles heel them. And again, in those focus groups this week, there were people that I agree with reform on immigration, but I've heard they're going to do something to do something to the NHS, and, you know, they do not like that.

Jennifer Dixon 

No, that's interesting. I think this duality between, on the one hand, rip it up, rage, nothing works, let's just burn it, and the other hand, this sense of rising threat, of perception, I think you wrote in one of your reports, and the need for security and preservation is quite an interesting duality. With respect to the National Health Services. Clearly, it's a major part of the security blanket the NHS to the nation. When you hear some of Nigel Farage's earlier comments about the NHS, I mean, I don't know how serious they were, but people who are adjacent to reform talking about the, you know, more of a free market health system, or, indeed, more laterally Germany or the Netherlands that we could go towards that. 

And yet, on the other hand, I heard a interview with James Orr, who's one of the people who are obviously trying to construct the policy for reform UK through the Centre for Better Britain, which is their think tank. He used the term he can encapsulate the sort of economic approach, as a ‘conservative nationalism’ is how we put it. And in a sense, the nationalism bit really speaks to the National Health Service. And a conservatism is almost a kind of preservation, is it not? Do you think that's where they may land? That's Reform UK for a minute on the National Health Service, despite the rage that's obviously there.

Luke Tryl 

I think it is. Look, the NHS is as close to a hygiene factor as you can get in British politics. And bear in mind, you know, no matter how much reform UK moderate, they're still going to be offering, in part, their appeal will be offering a more radical prospectus than Britain has seen for some years. You've got to then, as I say, to go back to that point about discombobulation, about rising threat perception. You've got to have the reassurance piece. And I simply do not think it would be credible for any political party to head into an election with a perception that the NHS is under threat in any way. 

When we asked looking to the future, would you like the NHS to be free at the point of views in 30 years’ time, 73% of Brits said they did. Only 15% said that they didn't. But perhaps rather depressingly, and I think this is where you know, reform will have to be careful with the NHS. When we ask the same question, which is, do you think it still will be free at the point of use in 30 years’ time, 50% say No, only 21% say they think it will be so. Again, that reassurance piece, I think, when it comes to the NHS, can be really important.

Jennifer Dixon 

Another interesting report you had, I think it was from September, which is looking at, again, at Reform UK, from protest to power inside reform UK's changing support base is, was the title, and you said that 42% of voters were now in reach of the party. But you also read that because of the shorter term, cycles of impatience of the public with the politicians, given there isn't change, there's almost a shorter window to make change. 

So there is a question that if Reform UK do form a government, and the big if, will they be given even less time than the current government has to make change, in which case the enraged will be even more enraged. And in a sense, the rage is not against established parties. The rage is focused on any incumbent, because they can't change things quickly enough. 

Luke Tryl 

Actually, if we go back to this government, you know, you find some people say, Oh, they're unfair. They've only had 18 months. How can people judge them? And I think, what, on the one hand, some of their public opinion own goals, such as the winter fuel allowance, and perhaps the sense that the political instability and turmoil that they promised to bring to an end have done it. But there is also a mistake, I think, in, and you saw this a bit in the Rose Garden speech, of assuming that we are in year zero when it comes to the public, that people will give 5 years to so people basically think that since the financial crash, and not unfairly, think this, they've been told it's time for tough decisions and things are going to be difficult. But you know, they got this new government, and they want to change quickly. 

So if you fast forward to 2029, let's work in the world where Reform UK win, the expectations, not least, given they branded themselves on this radicalism, are going to be even higher among their supporters and the demand for change even quicker. They won’t have much space or time to demonstrate that. And I think if they aren't able to demonstrate that change, then, I mean, who knows? Already, we're seeing people lose faith, not just in one party or another, but the system itself, as I said, and I think that that would turbo charge it. And I should say, you know, to the Donald Trump point, he is very unpopular, where you occasionally get grudging admiration among some Brits, is those people who say, I don't like him, but you know what, at least he does what he says he'll do, that move fast and break things approach. Whether Reform can do that in the British political system, whether they'll have the plans or the expertise. 

Jennifer Dixon 

When you look at the NHS, and some of us have been around quite a few decades now, looking at the way change happens, I think everyone in the system recognises that you build on what happened in the last 5 or 10 years, and that's how change largely happens. But on the other hand, you've got this impatience for rapid change, which often feels very superficial. And politicians, you can see the frustration with them, because they feel that these institutions are blobs, quite unfairly, probably, and they want rapid change, so what they end up doing is the things they can do, which is, of course, this endless reorganisation, which, you know, the public don't care a jot about. 

So is it possible to even change the weather system of public opinion on this, or attitudes to this, to sort of get them off the hook? Hook of this short-term change. It's a sort of flywheel change that we need here. Or is that just utterly naive? Is just that not possible in today's world where we've moved forward now into a very fast cycle social media, politicians, by celebrity status, if you like. A very rapid, moving, performative system. Is there any hope for getting some more sense into this when you consider the need to preserve some of these institutions, surely reform them, but the understanding the nature of change.

Luke Tryl 

Well, I think there's a couple of things there. I think one is, we are in an era of show not tell. And I think in order to get that license to embed some of that more gradual, longer term change, people have to see things as starting to go in the right direction anyway. And, and interestingly, you know, one of the things I found about a year ago was that it's not a great benchmark for improvement, but it is an improvement is that the horror stories I was getting in focus groups of waiting lists and A&E experiences did seem to drop off a bit and when we asked people, what has Labour achieved in their first year in office, within the word cloud, was massive, nothing in the middle of the word cloud, but the next was the NHS. 

When we have asked about some of the sort of specific measures in, you know, say the elective reform plan, you know, they're popular with the public, Labour's plans are important. Most people, I think 63% of the public, rank NHS waiting times as their top metric in judging the government success. So it's clearly, it's clearly there. 

On the flipside, I think I can be generous or feel a bit sorry for politicians, in terms of some of the expectations placed on them. But often they these expectations come from politicians themselves, promising the impossible or the rapid, or, perhaps worse, creating these bogey men, which seem easy to solve. So for instance, yeah, I'll do zoom out and then do an NHS specific one. When you ask people, would you rather pay more taxes for higher spending or lower taxes, lower spending. Most people say I shouldn't have to make that choice, because I keep being told there's so much waste, and they think there's a third option. Of course, all politicians run on efficiency and waste. People keep being told that by politicians. People think it right, so that's so that's one. That applies to all public services. With the NHS in particular, there is still a real narrative, and I've heard it in countless focus groups over the past couple of years, that part of the reason things have gone wrong is because there's an overpaid management class. Right?

Jennifer Dixon 

Again, that's stuff in the memes in the media on that.

Luke Tryl 

Exactly. But I think actually, again, some of the challenger parties have themselves talked about that, and that reinforces it. And so people think you know, if only you know, when you ask about things like resident doctors pay, well, can't we just cut the managers pay to deal with them, or get rid of these managers? 

Jennifer Dixon 

So in summary, if we are just getting a jittery about what's going to happen to the National Health Service and what politicians might do, what the public mood is, from what I'm gathering, you don't see that there's anything that's changing the dial too much on the solid support of the NHS. And that the parties, at least in the election period, won't dare to say much on that. But, even afterwards, even if there was a reform, UK government, obviously won't hold you to this, that actually preserving the security is likely to be an important feature. Is that surmising too much, from what you've said, Luke? 

Luke Tryl 

No, no, I think it is, I think it is, look, look, people want reassurance and control for government. And I think, you know, changing the model of the NHS changing it more fundamentally, I do not think will provide that. And you know, to quote Sir Humphrey, which is always a good place to end the thing, he would be very brave for any politician to do that. I could be wrong. I don't make predictions, but I would be surprised if that happened. I guess the more interesting question was where we were just focusing at the end, there. How can any government build that kind of space to make some of the more fundamental changes in terms of things like capacity, to make the NHS work in a way that people expect it to?

Jennifer Dixon 

Thanks very much to my guest, Luke, for his insight today. We'll be returning to the same questions next time, when I'll be putting them to Rachel Wolf, who is the CEO of Public First. Meantime, thanks as ever, to Leo and Sean at the Health Foundation, to Paddy and his team at Malt productions, and until next time, goodbye from me, Jennifer Dixon.