Image source, Getty Images

Alongside the pressures on the NHS, another issue we can expect Sunak to be pressed on this afternoon is what he will do about childcare.

The UK is among the most expensive countries for childcare in the world, according to the Organisation for Economic Co-operation and Development.

Former prime minister Liz Truss had been looking at increasing free childcare support by 20 hours a week and scrapping mandates for a certain number of staff per child in nurseries to reduce the cost of childcare.

Rishi Sunak will reportedly postpone those plans indefinitely in favour of much smaller reforms.

This has led to growing frustration from some Tory MPs, with Truss believed to be among those with concerns.

In a tweet, former minister and Truss ally Simon Clarke criticised the prime minister, saying: "We should do all we can to support working mums."

According to the Institute for Fiscal Studies (IFS), government spending on free childcare for young children in England is set to fall by 8% in real terms over the next two years.

The government has said it is putting an extra £160m into early years but analysis from the IFS , externalsays funding is not keeping up with rising energy bills and other costs.

No 10 sources say Sunak is working on a series of options with the education secretary to improve the system.

Prime Minister Rishi Sunak is due to start speaking in around an hour's time.

We'll be covering his first speech of the year and following up with analysis by our correspondents on this page - stay with us.

He's expected to talk about the importance of dealing with backlogs in the NHS and set out plans for all pupils in England to study maths in some form until 18.

He will also face questions from journalists - and could be pressed on pressures in the health service, childcare reforms, migrant boats, striking workers, and more.

Let's hear from someone now who knows a great deal about the pressures the NHS faces. Dr Julia Patterson, the founder and head of campaign group EveryDoctor, says everything being said about a "broken NHS" is true.

Ahead of PM Rishi Sunak's speech later, she says the government has taken to framing the situation "in terms of money, and they're essentially washing their hands" of any responsibility.

On the seriousness of the system's failures, Dr Patterson says the government is tasked with running a "safe health service, which we all rely on, and they have a duty to provide such a service to the UK public".

Instead, she tells the BBC, ministers have reduced what she calls a "humanitarian crisis" to a political debate. "They're mispresenting the situation", they're "scapegoating staff" and they're still blaming issues such as Covid," she says.

The NHS "was already in a bad state, and yes it's been made worse by Covid" but this demand on the system is not new - "it's been bubbling for years".

Image source, Rachel Walter

With Rishi Sunak set to address some of the issues the NHS faces later today, we're hearing from people who've told us about how winter pressures on the health service are affecting them.

Jean Stringer, 90, waited 23 hours for an ambulance after she fell down the stairs and broke her hip. She had to lie on the floor from 15:30 on Boxing Day until 14:45 the following day.

Her granddaughter Rachel Walter, who works for the NHS as a practice nurse, said her grandmother was in so much pain that her family could not move her while they waited at her home, near Gloucester.

When Stringer eventually arrived at the hospital just after 16:00 on 27 December, she had to wait inside the ambulance for four hours.

Walter described the situation as "soul-destroying" for all the nurses, paramedics and doctors "who are working their socks off and doing the best they can".

Why are things so bad in the NHS?published at 12:28 Greenwich Mean Time 4 January 2023

12:28 GMT 4 January 2023

Nick Triggle
Health correspondent

The NHS is in the middle of its most difficult winter for a generation.

Whether it is the long waits in A&E or the delays being seen in getting ambulances out to emergency calls, the problems are the undoubtedly worst they have been since modern records began nearly 20 years ago.

An ageing population coupled with a squeeze in funding over the past decade has left services struggling to cope. While the budget has increased, these rises have been half what the service has traditionally got and (many argued) has needed.

The situation has been exacerbated by the pandemic. While the NHS was able to weather the surge in Covid patients that was seen in the first 18 months, the long tail of the pandemic has continued to pose problems.

The population is undoubtedly sicker and frailer – many people with chronic conditions such as heart disease did not get the support they needed at the start of the pandemic.

And Covid remains a pressure on the system – one in 10 hospital beds are occupied by patients with the virus. To add to that, there has been a rebound in flu this winter.

It has left hospitals desperately short of beds, causing delays for those coming in the front door.

The situation has been made worse by the fact that there is a lack of support in the community to allow hospitals to discharge patients when they are ready to leave.

The NHS is, as many have pointed out, close to gridlock.

Image source, Getty Images

Rishi Sunak will set out his priorities for the year this afternoon - stick with us as we run through the key issues before his speech.

First, the struggles within the NHS. Why are many people talking about it as a crisis?

The Royal College of Emergency Medicine (RCEM) has said the NHS is facing the worst winter for A&E waits on record, and that some A&E departments are in a "complete state of crisis".

A number of hospitals have declared critical incidents in recent days, meaning they cannot function as usual due to extraordinary pressure.

GPs are also facing massive pressure - a sicker population and packed hospitals mean they are working long hours and providing more emergency care.

Nurses and ambulance workers are set to strike again over pay later this month.

Opposition parties have accused the prime minister of being "missing in action".

On Tuesday, No 10 said the government was "confident" it was "providing the NHS with the funding it needs". The PM's spokesperson said the service was facing an "unprecedented challenge", but insisted the government was doing "everything possible" to ease pressure.

Image source, .

We're looking ahead to the prime minister's big speech this afternoon and we want to hear your views. How are you feeling about the year ahead? What do you think about his idea of making sure everyone studies maths until the age of 18? What else would you like to hear from him?

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Image source, Press Association

As we've been reporting, Rishi Sunak is expected this afternoon to set out plans for all pupils in England to study maths in some form until the age of 18. But a headteachers’ union has warned that this can't become a "pet project" for the prime minister.

Geoff Barton, general secretary of the headteachers' union the Association of School and College Leaders, says it’s important that the PM set out evidence that the plan will work before “embarking upon a significant change affecting future generations".

The plan may help young people get jobs and "cope with modern life" - but the PM must say how the policy would avoid “exacerbating the already-chronic national shortage” of maths teachers, Barton says.

Other experts are also flagging the shortage of teachers.

David Robinson, director for post-16 and skills at the Education Policy Institute, says he welcomes the idea of more students studying maths for longer, but that the "existing shortfall of qualified maths teachers" is one of the "major issues" that needs addressing first.

Other problems include education funding levels for 16 to 18-year-olds, and a need to help students who are studying vocational and technical qualifications, rather than taking A-levels.

Maths teacher (and former University Challenge whiz) Bobby Seagull says it’s “really vitally important” to make sure there are enough teachers to achieve the prime minister’s aim of teaching maths to 18 in schools in England.

He says the key issue the government is trying to address is functional numeracy – the ability to use maths on a day-to-day basis.

“I see as a teacher there’s a spectrum of abilities. Some people pick up maths quickly, some people need a bit more time,” he told BBC Breakfast earlier.

“But for day-to-day life, whether you’re checking your bills, shopping, planning a holiday or planning your journey into work, you need practical maths skills."

Asked how the plans could impact pupils who don’t feel confident about maths, he answered: “Maths is a skill like any other thing - like when you’re learning to drive, bake, dance or sing”.

He urged the government to focus on teaching personal finance so pupils can better understand mortgage rates, rents, interest and inflation.

Image source, Getty Images

The Liberal Democrats say the government’s plan for all pupils in England to learn maths until 18 is “an admission of failure from the prime minister on behalf of a Conservative government that has neglected our children's education so badly".

The party's education spokesperson Munira Wilson, said: "Too many children are being left behind when it comes to maths, and that happens well before they reach 16.”

"The prime minister's words mean nothing without the extra funding and staff to make it happen.

“You don't need a maths A-Level to know it takes more teachers to teach maths to age 18 than to 16.

“But schools are already struggling with a shortage of maths teachers, and the Conservatives have no plan to turn that around.”

Labour has criticised the prime minister's plan to ensure all pupils in England study some form of maths until they're 18 as an "empty pledge".

Labour's shadow education secretary Bridget Phillipson called on Sunak to "show his working" on how greater participation in maths would be funded.

"He cannot deliver this reheated, empty pledge without more maths teachers, yet the government has missed their target for new maths teachers year after year," she said.

Sunak is poised to announce the aim in his first speech of 2023 later.

He is expected to say the UK must "reimagine our approach to numeracy".

The PM will say: "In a world where data is everywhere and statistics underpin every job, our children's jobs will require more analytical skills than ever before."

Chris Mason
Political editor

The idea to ensure all young people in England up the age of 18 are studying maths in some form appears to be an aspiration rather than a policy idea that's fully developed.

The precise mechanics for making it happen are not clear and the government acknowledges it wouldn’t be possible to implement before the general election.

It's an attempt by the prime minister to speak to some of his broader interests beyond the day-to-day firefighting of government.

His argument is that a growing number of jobs rely on mathematical ability and the education system needs to change to reflect that.

But critics, including the Labour Party and the Liberal Democrats, point to a failure to recruit enough maths teachers.

Sam Francis, political reporter and Branwen Jeffreys, education editor

Image source, Downing Street

In his speech later today, Rishi Sunak is expected to set out plans to ensure all pupils in England study maths in some form.

It’s not clear what the plans will mean for students who wish to study humanities or creative arts qualifications, including BTecs.

No new qualifications are immediately planned and there are no plans to make A-levels compulsory.

The government is instead exploring expanding existing qualifications as well as "more innovative options," a 10 Downing Street spokesperson said in a briefing ahead of today's speech.

The prime minister is expected to begin working on the plan in this parliament and plan to finish it after the next general election.

• Read more here

We're continuing to look at some of the issues that could come up in Rishi Sunak's speech later.

The prime minister finished the year with a major victory under his belt when the High Court ruled that his government's plan to deport illegal migrants to Rwanda was lawful.

But the charities and human rights activists who brought the challenge against the Home Office have vowed to continue opposing what they believe is an unworkable and inhumane scheme. The government has said it will fight any further legal action.

The issue isn't going away either. On Monday, 44 migrants arrived in the UK, in the first small boat crossing of the new year. One question is whether Sunak decides to mention this in his speech.

Image source, .

It may well be a new year but strikes that kicked off in 2022 are continuing to play out across the UK.

From the railway to the roads, through to schools and the NHS, this month alone will see workers across more than five sectors stage walkouts.

Industrial action by health and rail staff, in particular, have caused big headaches for the Sunak administration.

All eyes will be on the prime minister today to see if there's any movement on the government's side in trying to resolve the disputes.

Image source, .

The NHS is not the only challenge facing Prime Minister Rishi Sunak this year.

The cost of living in the UK is set to increase even further this year, primarily at home - with a cap on energy bill prices coming to an end in April.

Former PM Liz Truss brought in the current cap - limiting prices to an average of £2,500 per household per year. But following her departure, Chancellor Jeremy Hunt announced that help would be less generous from April. Typical bills will increase to £3,000, he said - although there will be help for the most vulnerable.

This was a key issue in the Tory leadership race over the summer and is set to be a focus for the Sunak administration in the year ahead.

Image source, .

NHS wait times and a general dissatisfaction with the service dominated national headlines at the end of last year, culminating in the nurses’ and ambulance workers’ strikes just before Christmas.

With more nurses set to strike later this month, Rishi Sunak will know this is one of his most significant challenges going into 2023.

In his speech today, the prime minister is expected to talk about issues including backlogs in the system and problems getting ambulances.

Image source, .

Chris Mason
Political editor

On the provision of childcare to pre-school children in England, I understand there is nothing imminent coming from the government, but the prime minister accepts it is a difficult issue for many families.

There is irritation in Downing Street at the intervention of the former prime minister Liz Truss. Those around her say the abandoning of her plans to expand the provision of free childcare and allow nursery staff to look after a greater number of children is "economically and politically counterproductive".

No 10 sources point out Truss’s plans were not fully developed and would be very expensive – particularly the expansion of free childcare.

Labour’s shadow health minister Rosena Allin-Khan said the “NHS is in crisis” and it is currently the worst she's ever seen, having been an emergency doctor for 17 years.

Speaking to BBC Radio 4’s Today programme, she said Labour had a workforce plan to train 10,000 more nurses and midwives each year, double the number of district nurses, and create 5,000 more health visitors.

Labour’s shadow health secretary Wes Streeting has also called for reform, saying “we cannot continue pouring money into a 20th-century model of care that delivers late diagnosis and more expensive treatment”.

Asked if the standard of care for patients needed to be improved as well as increasing the number of NHS staff, Dr Allin-Khan said: “People are being treated in the most undignified of ways, of course things need to be improved for patients.

“But that is currently at the hands of the government and they are failing to do that - we have a prime minister that is missing in action.”

Asked if she would like to see the use of the private sector to clear backlogs as Streeting has suggested, Dr Allin-Khan said: “In my own brief in mental health, we have use of the private sector, which ultimately often lets patients down. This is about putting patient care first.”

Chris Mason
Political editor

In the speech this afternoon setting out his priorities for the year ahead, Rishi Sunak will talk of the importance of dealing with backlogs in the health service.

Problems getting an ambulance, waiting times for planned operations and social care in England are all likely to be referred to by the PM later, as critics demand immediate answers to what is widely seen as a crisis in the NHS this winter.

Those around Sunak say his instinct is that to have more than a few priorities at any one time is to have no priorities at all - and the situation in the NHS is uppermost in his mind.