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Championship play-offs: EFL clubs vote in favour of six-team play-off

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EFL clubs have voted in favour of expanding the Championship play-offs from four to six teams.

The new system will mirror the format used in the National League and will be introduced for the 2026-27 season.

It means teams finishing from third to eighth will compete for promotion to the Premier League.

Clubs finishing third and fourth will progress directly to the semi-final, while a one-legged quarter final will be played with fifth at home to eighth and sixth hosting seventh.

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Semi-finals will remain as two legs and the final will still take place at Wembley at the end of May.

The proposal has been under consideration for a number of seasons and was approved by the EFL board and Football Association.

“The decision is intended to increase the number of competitive fixtures during the closing stages of the campaign, while also giving two additional clubs the opportunity to reach the play-off final at Wembley Stadium and progress to the Premier League,” the EFL said.

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Labour considering suspending MP whose husband is suspected of spying

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David Taylor has been bailed along with two other men arrested in Pontyclun and Powys on Wednesday. His wife Joani Reid read a statement in the Commons on Wednesday in which she said she denied any wrongdoing

The leader of Scottish Labour has said the party has “judgements to make” on an MP whose husband is suspected of spying for China.

The Scottish Labour leader Anas Sarwar said on Thursday Labour has “judgements” to make on MP Joani Reid, who is an MP for East Kilbride and Strathaven and whose husband David Taylor, from Ruthin, was arrested on Wednesday as part of an ongoing investigation into alleged spying.

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Mr Sarwar made the remarks amid speculation the UK Labour Party could suspend Ms Reid. On Wednesday the Metropolitan Police said three men – aged 39, 43 and 68 – were arrested by counter-terrorism officers in London and Wales on suspicion of assisting a foreign intelligence service.

The men were detained under the Police and Criminal Evidence Act, according to Commander Helen Flanagan, head of counter terrorism policing London.

Taylor has been bailed along with two other men arrested in Pontyclun and Powys on Wednesday. Ms Reid read a statement in the Commons on Wednesday in which she said she denied any wrongdoing.

On Thursday Mr Sarwar said of Ms Reid: “We are considering all these matters because they are serious questions that you are putting to me. As you know, we have an independent Governance and Legal Unit that’s considering many of these matters and we will have judgements to make today.”

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Asked if Ms Reid should be suspended, Mr Sarwar said: “This is rightly an independent Governance and Legal Unit process. We are looking at all the questions that arise from this and we will be making judgements on this.”

Mr Sarwar said he last came into contact with Taylor “probably at some point last year”. “He is not someone who is well known to me,” he said.

A Labour source said suspension and an internal investigation would allow Reid to show she has done nothing wrong, the Daily Record reports.

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In a statement on Wednesday Ms Reid strongly rejected any claims of wrongdoing. She said: “I have never been to China. I have never spoken on China or China-related matters in the Commons. I have never asked a question on China-related matters.

“As far as I am aware, I have never met any Chinese businesses whilst I have been an MP, any Chinese diplomats or government employees, nor raised any concern with ministers or anyone else on behalf of, even coincidentally, Chinese interests.”

Taylor was special adviser to Peter Hain when he was Welsh secretary and also previously worked for Senedd member Leighton Andrews when he was a backbencher. He was also selected as Labour’s candidate as police and crime commissioner in north Wales in 2016.

He is listed on the MP’s register of interests as a director of Earthcott Limited, a lobbying firm. He previously founded a cyber security company and his LinkedIn profile states he is director of policy and programmes for an organisation named Asia House.

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His profile states: “At Asia House I lead our policy and research teams in delivering programmes and projects for clients across Asia, the Middle East, and Europe. I oversee the development and execution of strategic initiatives that connect senior government officials, business leaders, and thought leaders on critical regional and global issues.”

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Community Rallies Around Claire’s Floristry & Tea Room as Business Celebrates Two Years

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Community Rallies Around Claire’s Floristry & Tea Room as Business Celebrates Two Years

On any given day, the scent of fresh flowers mixes with the sound of conversation, laughter and coffee cups in a small shop that has quietly become one of the area’s most welcoming community spaces. What started as a personal dream for local florist Claire has grown into something far bigger — a place where people come together.

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Life lessons: Naz Shah on what life so far has taught her

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Life lessons: Naz Shah on what life so far has taught her

The British politician on being optimistic, what she learned from her incarcerated mother, and her enduring faith in community

My morning ritual is …

I get up and take my thyroid medication. You can’t mix it with any caffeine, as it makes it obsolete, so half an hour later I have a ginger tea. That’s the thing that gets me up and about. No two days are the same with my job, but I often start work with early meetings.

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I feel optimistic about …

Getting healthier. I’ve had some major surgeries this year. I feel optimistic about the future and hopefully getting more of a work-life balance because I don’t have that currently. I always feel optimistic about learning new things too.

What makes me angry …

People who try to divide people. The kind of people who try to fan the flames of division make me really angry.

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If I wasn’t a politician, I’d have liked to become …

A barrister. If I could go back to an education, that would definitely have been what I had my dreams set on. When you come from where I’ve come from and the life I’ve had, you don’t want anybody else to go through that. My life has been all about not having that fairness, not having equality or having justice – that is the thing that frames me and context that I view the world through. It’s all about justice and equality. I’d have liked to have become a barrister, a Michael Mansfield sort of character. Representing people and giving them a voice, you have an opportunity to change things.

The habit that has served me best in life …

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Optimism. It’s about continuously seeking the light, even when it’s dark and I can’t see. It’s about resilience and making sure I carry on.

The habit I’ve successfully kicked …

Eating too many biscuits. It’s a bad habit that I have: Custard Creams, Chocolate Hobnobs, Bourbons… I’ve reduced my biscuit intake these days. But I still have more to kick.

If you’re true to your faith, your humanity and your values, you will make the world a better place

My sources of joy are …

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My children, and music. I love good, old school R&B, dance and house classics from the 1980s and 1990s. I’m talking about Blackstreet, Jagged Edge, Destiny’s Child, Mary J Blige… Some floor fillers just get you going. I love dancing but I don’t get time for it anymore.

When things get tough I …

Turn to God. I always turn to my faith, Islam, when things get difficult. That’s where I find my sanctuary, my solace and my calm.

The book I wish everyone would read …

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One of my all-time favourite books is The Seven Habits Of Highly Effective People by Stephen Covey. It really impacted my thinking, shaped my understanding and gave me a framework for leadership in my early days and the start of my career.

‘People have the answers but they don’t have the means to get to those answers,’ says Nav Shah. Image: Mauro Mora

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The big thing I’ve changed my mind about in life …

Is that being busy isn’t the same as being productive, and that work-life balance isn’t a ‘luxury’ – it’s essential for long-term performance.

What keeps me awake at night …

Is my job. My brain overthinks things. I’m a solution-focused person – I’m thinking about solutions for society’s problems. What makes me angry also keeps me up at night.

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The thing that motivates me most of all …

My faith. If you’re true to your faith, you’re true to humanity and to your values. If you’re true to all that you will live to make the world a better place. The bottom line is equality, fairness and justice. Reducing inequality is my main driver. I’m driven to help people that are in a less fortunate position. I’m very strong in my belief that God has given me a gift, and that the power and status and power I have has to be spent in helping humanity and improving society.

My mother spent 14 years in prison and taught me how to hold on to the light

My parents taught me …

My dad taught me how not to behave. He taught me how not to take responsibility, for children and for life. He abdicated his responsibility for his children. He didn’t step up. I’m the complete opposite – I take responsibility. My dad also taught me how to dance – I got my love of dancing from him at an early age.

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My mother taught me patience and resilience. She spent 14 years in prison [When Naz was 18, her mother killed a man after enduring more than a decade of abuse from him] and she still taught me how to hold on to the light. She gave me the foundation for my strength. She taught me how to never give up.

I have this theory that …

Communities have their own solutions. People have the answers but they don’t have the means to get to those answers. For me, there is zero poverty of aspiration among communities. But there is a poverty of infrastructure to allow people to fulfil those aspirations.

I’d like to tell my younger self …

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To read more books and to learn more languages. I’ve just started reading very recently. I left school at 12 and I should have read more. I’m thirsty for knowledge. I’ve always done a lot of experiential learning from work and things like that. But I’ve just recently started finding the joy in books.

Honoured: Survival, Strength And My Path to Politics by Naz Shah (W&N, £22) is out now.

Main image: House of Commons

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William Osula: Newcastle scorer won Man Utd skills contest aged 11

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Manchester United post on X/Twitter from 2014 congratulating William Osula for winning a skills contest

Unsurprisingly, that post has resurfaced into the wider consciousness in the aftermath of Osula’s superb late goal that secured a 2-1 win for Newcastle against United.

Born in Copenhagen, he joined Sheffield United’s youth set-up in 2018 and has played for Denmark Under-21s.

Now 22, Osula has been predominantly used as a substitute by Newcastle since his move to St James’ Park from the Blades in the summer of 2024.

His goal on Wednesday was his third in 30 Premier League appearances for Newcastle, although 29 of those outings have been from the bench.

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Micah Richards raises Man Utd transfer concern after Newcastle defeat | Football

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Micah Richards raises Man Utd transfer concern after Newcastle defeat | Football
Manchester United’s unbeaten run under Michael Carrick was brought to an end at Newcastle (Picture: Getty)

Micah Richards says Manchester United’s dramatic 2-1 defeat to Newcastle was further proof that the club ‘need to go and recruit’ to improve their strength in depth in the summer.

Michael Carrick suffered his first major blip since taking charge of United as a spirited Newcastle prevailed at St James’ Park despite losing Jacob Ramsey to a red card at the midway point.

The Red Devils had appeared to have swung the momentum back in their favour after Casemiro headed home to cancel out Anthony Gordon’s opener from the penalty spot in a frantic end to the first half.

Just moments earlier, Jacob Ramsey had been shown a second yellow card for an apparent dive, reducing the hosts to ten men for the entirety of the second period.

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But the Magpies refused to lie down and Howe’s decision to remove Gordon for William Osula in the 85th minute proved a masterstroke, with the latter providing the standout moment of quality to win it at the death.

Senne Lammens could only watch on despairingly as the young Dane cut in from the right touchline before finding the net with a unstoppable curling effort to send the home crowd into raptures.

‘We’re not happy with the way we played the game tonight,’ United interim manager Carrick told reporters at his post-match press conference shortly after the final whistle.

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Newcastle United v Manchester United - Premier League
Osula took the roof off St James’ Park after replacing Gordon (Picture: Getty)
Newcastle United v Manchester United - Premier League
Carrick’s men now have a break before hosting Aston Villa (Picture: Getty)

‘The way the game panned out, I think we had it in our hands largely, but credit to Newcastle, the way they approached the game.

‘We knew it was going to be a tough game here, we navigated the game to be in a position where we felt we should kick on but we didn’t. So yeah, bitterly disappointed.’

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Asked why his players had struggled to gather any momentum despite having a man advantage, Carrick replied: ‘I don’t think it was the ten men, we just didn’t play good enough tonight.

‘We can’t make any excuses for that, we all take responsibility for that.’

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For Carrick, it is perhaps fortunate that his players now have a week and a half to regroup and find their feet again before returning to Premier League action at home to Aston Villa – who sit below them only on goal difference.

Analysing the game in the Match of the Day studio, ex-Manchester City and England defender Richards made sure to praise Newcastle for the resilience they showed when going a man down at the end of the first half.

‘The crowd behind them, roaring them on, I thought they were excellent,’ he said.

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United ‘need to go and recruit’ well in the summer transfer window, says Richards (Picture: BBC)

But turning his attentions to the visitors, Richards suggested the limp performance from United demonstrated where the club were still badly lacking in their squad.

‘I feel as though they’ve done so well in recent weeks and if you look at their starting XI, it’s very good,’ he explained.

‘Then you start to look at the bench and it doesn’t have the same impact as well.

Newcastle United v Manchester United - Premier League
The Red Devils still sit third despite the setback (Picture: Getty)

‘So they’ve got the first bit right… now, in the summer, they need to go and recruit.

‘The last time Carrick lost points [away to West Ham] was when they played two games in a week.

‘So it’s showing they can’t maybe deal with that and the players coming on aren’t giving the same impetus. That’s something to look at for Manchester United.’

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According to Richards, the decision to reduce Newcastle to ten men was questionable at best given it was a case of Ramsey ‘losing his balance’ rather than the player trying to con the referee.

‘He just loses his balance, that’s all it is,’ the 2012 Premier League winner argued.

‘You can see when the ball goes through, he makes a terrific run but he just loses balance. It’s as simple as that.

‘It’s not a second yellow card, he didn’t deserve to get sent off and it’s as simple as that.’

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OverDraught, Radcliffe facing fresh licensing action

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OverDraught, Radcliffe facing fresh licensing action

Bosses at OverDraught are due to appear before a licensing panel at Bury Council on March 12 after Greater Manchester Police applied for another review of the venue’s licence.

The hearing comes after police said the premises remained open for a lock-in until after 5am on December 20, despite its licence only allowing alcohol to be sold until 2.30am.

The bar’s premises licence has already been subject to two expedited reviews and full hearings in just under two years following incidents of serious crime and disorder.

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The most recent review took place on December 3, 2025, when the licensing sub-committee imposed additional conditions on the bar following concerns about a pool cue attack last November.

This incident followed separate violent disorder issues at the venue, including a knife incident in January 2024, a man being ‘bottled’ in March 2025, and a toilet attack in June last year.

Amended conditions included locking away pool cues and balls after 10pm and enforcing plastic cups rather than glasses after 9pm.

Police say those conditions appeared to have been followed in the run-up to Christmas after several checks.

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However, officers later received information suggesting the bar had stayed open late to show a boxing fight between Jake Paul and Anthony Joshua in the lead-up to Christmas.

No Temporary Event Notice had been submitted to allow extended hours, GMP said.

PC Peter Eccleston from GMP contacted the licence holder and designated premises supervisor Alistair Johnson in January.

During the conversation, Mr Johnson said that once most customers had left at closing time, he locked the doors and allowed “two or three” friends to remain to watch the fight.

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But CCTV evidence later supplied to police suggested a larger number of people were still inside the venue and that alcohol continued to be served.

A still image from the venue’s CCTV system taken at 3.27am showed at least 12 people inside with “an assortment of glasses, predominantly pint glasses at varying levels of volume”, visible on tables.

Further CCTV reviewed by police showed drinks being served over the bar at 2.50am and again after 3am, with additional sales recorded after 4.30am.

The footage also showed several people smoking inside the premises, including at 4.42am.

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The last customer was seen leaving shortly after 5.14am, with staff and the designated premises supervisor leaving minutes later.

In the report to councillors, police said Mr Johnson acknowledged several people remained inside the bar and admitted supplying alcohol to family members, staff and friends.

However, officers said the activity breached the premises licence.

PC Eccleston said the bar owner had “knowingly undermined the licensing objectives” despite having more than 15 years’ experience in the trade.

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Police said the circumstances were particularly concerning given the bar’s recent licensing history.

The venue has already faced scrutiny following the violent incidents, including an attack involving a pool cue that previously prompted calls for its licence to be revoked before conditions were tightened.

The force says Mr Johnson was “pleading with PC Eccleston” not to review the licence and said he “allowed the sale of alcohol due to being closed on some of the key dates over the Christmas period, and as such, wanted to bring in some extra revenue to help cover the shortfall”.

PC Eccleston added: “Given the serious breach of license, Greater Manchester Police feel that it is necessary to bring this incident to the attention of the Licensing Sub-Committee.

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“Although Mr Johnson has openly admitted to his failings and he appears to be taking full responsibility, given that the premises have had two expedited reviews in just over two years, you would expect a very different approach from someone with his experience.”

Councillors will now decide whether further action should be taken against the premises licence when the panel meets next week.

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Millions in Cuba hit by blackout as Trump embargo bites | World News

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A man crosses a street in Havana, Cuba, after a power outage at a thermoelectric plant. Pic: AP

Millions of people were left without electricity in Cuba after a shutdown at one of the country’s largest thermoelectric power plants.

The capital Havana and the rest of western Cuba – from the western town of Pinar del Rio to the central town of Camaguey – were left in darkness after the power cut on Wednesday.

Government radio station Radio Rebelde quoted an energy official saying the problem was due to a boiler leak at the Antonio Guiteras plant, about 62 miles (100km) east of Havana.

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A man crosses a street in Havana, Cuba, after a power outage at a thermoelectric plant. Pic: AP

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Vicente de la O Levy, Cuba’s energy minister, wrote on X that the government was powering critical infrastructure – including hospitals and medical clinics – in the affected region.

Meanwhile, the US Embassy warned American citizens in Cuba to “prepare for significant disruptions” and to conserve fuel, water, food and mobile phone batteries.

By Wednesday afternoon, Cuba’s government said crews had restored power to 2.5% of Havana – around 21,100 – noting that efforts were gradual and tied to what the system’s conditions would allow.

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And by Thursday morning Cuba’s Energy Ministry said the national electrical grid had been reconnected from Guantanamo in eastern Cuba to Pinar del Rio in the far west and power generation was being brought back online.

In Havana, according to local utility EELH, 22 substations and 102 distribution circuits accounting for roughly 36% of the city had been restored – a process the firm said would proceed gradually, as conditions in the national grid allowed.

It’s the second widespread blackout to hit Cuba in three months, and comes after the country was placed under a strict oil and fuel embargo by the Trump administration last month, which caused an oil shortage and, according to international charities, a humanitarian crisis.

Pics: AP
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Pics: AP

An outage in early December lasted nearly 12 hours, after officials said a fault in a transmission line linking two power plants caused an overload and led to the collapse of the energy system’s western sector.

The country has seen dwindling oil reserves after the US military captured Venezuelan President Nicolas Maduro and his wife in early January, which led to critical petroleum shipments from South America being halted.

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The US has also maintained a strict trade embargo on Cuba since 1962, the year after a failed, CIA-sponsored invasion of the island at the Bay of Pigs.

Map showing Cuba and Florida
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Map showing Cuba and Florida

Donald Trump extended that blockade by signing an executive order imposing trade tariffs on countries exporting oil to Havana last month.

The UN Office of the High Commissioner for Human Rights said experts condemned the move, and accused the US of a “serious violation of international law and a grave threat to a democratic and equitable international order”.

Mexico and Canada have sent aid to Cuba in the wake of the embargo. But the Caribbean country had been already struggling with a crumbling electric grid, generation deficits and interruptions in fuel supplies.

Read more from Sky News:
Shoplifter who killed Asda security guard jailed
£22m fine for South East Water over supply failures
Congress votes to summon Bondi over Epstein files

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Earlier this week Lindsey Graham, Republican senator for South Carolina and an ally of the US President, hinted that the Communist regime in Havana could be targeted next by the US military.

Last Friday, Mr Trump also told reporters outside the White House that there was a possibility of a “friendly takeover of Cuba”, without offering details on what he meant.

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How To Water Every Type Of Plant

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How To Water Every Type Of Plant

Watering should be so simple; pour water on thirsty plants, which gratefully sup up exactly what they need to flourish.

Unfortunately, Mother Nature is a bit more complicated than that.

There are wrong and right times to water your plants. You can over-water and under-water them. And plants lose some water through transpiration that can be hard to measure.

So, we thought we’d collect the best watering tips we’ve seen so far.

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1) Pick up plant pots

Dehydrated potted plants will feel lighter than usual as the moisture content has left the dirt. If it’s less heavy than it should be, water it.

2) Generally speaking, you should water in the morning

Not only does this help to stop slugs from eating your leaves, but it is also when plants are most able to absorb water. It comes just before their most active and water-heavy part of the day, too.

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3) Use the “knuckle test” to check soil moisture

It might seem like your flourishing flowers prove they’re getting enough H2O. But actually, you can’t tell if the soil beneath is properly hydrated without touching it.

4) Water containers with 10% of their volume

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Plants in containers tend to need more water than those in the ground, because their soil isn’t as deep. When watering them, try adding 10% of the container’s volume (so 1L for a 10L pot), the Royal Horticultural Society (RHS) said.

5) Choose rainwater when possible

Rainwater has a pH and mineral content that plants really, really love. Try to use a water butt throughout the year, keep the rainwater in your plants by mulching them, and/or place saucers under your containers.

6) Aim water right at the base of your plants

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When watering garden plants, place the nozzle of a watering can right at their base, below the foliage, so that the roots have a chance to access it.

Some potted plants, meanwhile, will benefit from having their entire base submerged in water from time to time instead of the odd sprinkling.

7) Know the signs of dehydration

Plants all need a different watering schedule. But most of them share similar signs of dehydration, including dull leaves, decreased flower and fruit production, downward-facing or curling leaves, and lighter potted plant weight.

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8) And learn the signs of overwatering, too

Wilting, which can also be a sign of underwatering, happens when you’ve overwatered them too; lift the plant up to see if water’s gathered at its base to see what you’re dealing with.

Other signs include yellowing leaves, mouldy patches, stem rot, and dark roots.

9) Don’t let leaves stay wet for too long

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This can cause disease and even scald the leaves, especially “hairy” ones, in heatwaves.

10) Use water smartly

I can’t remember the last summer we didn’t have a hosepipe ban (and it turns out hoses aren’t usually the most efficient watering method anyway). Embrace “grey water” from your bath, sink, and shower; soil is usually more than capable of filtering out detergents.

Having a rain butt, keeping grass clippings on your lawn after mowing, and mulching with everything from stones to coffee grounds can help too.

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Exact time people will get best view of ‘blood rain’ sunset display today, Thursday March 5

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The Met Office said Saharan dust is being blown north across parts of Europe and towards Britain

Saharan dust and “blood rain” are expected to bring colourful skies to the UK on Thursday on what could be the warmest day of the year so far. The Met Office said Saharan dust is being blown north across parts of Europe and towards Britain.

Temperatures on Thursday could reach 19C or 20C, which would beat the previous 2026 high of 18.7C recorded in Kew Gardens last week. A Met Office spokesperson said: “The London area is expected to be the warmest part of the country today with temperatures in the high teens quite widely.”

The Saharan particles in the atmosphere transform ordinary sunsets into vibrant displays of oranges and reds, but also mix with rain to produce a red residue. Sunset today is around 5.45pm – meaning in the period 5.15 – 5.45pm will probably have the best show.

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Jim Dale, senior meteorological observer at British Weather Services, said: “Blood rain is a dramatic title. There is no blood involved at all, it is the colour.

“Saharan dust is very fine sand particles off the Sahara desert which get lifted by the wind. “The dust of the sand comes down, joins with raindrops and it leaves a film of sand or dust that is red/brown coloured on surfaces such as cars.”

Claire Ryder, a professor at the University of Reading who specialises in dust transport, explained the dust is brought over to the UK by strong, warm winds coming from the south.

“The dust particles are smaller than a grain of hair and can stay in the air for a long time,” she said. “They will slowly be settling but they can also be taken out of the atmosphere by rainfall and clouds.”

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Dr Ryder believes the best sunsets will be across the east of England on Thursday evening. She added: “The peak dust concentration is through tonight and it is going to get much more severe through the night and into tomorrow.

“Tomorrow, skies will be less visible as it is more cloudy so the best chance to see a great sunset is this evening.”

Clouds are expected across much of England and Wales on Friday, although Ireland and Scotland should enjoy sunny weather, according to the Met Office.

Temperatures will also drop to around 11C-12C across England and Wales on Friday.

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The weekend will be a mix of patchy cloud and some sunshine, with high temperatures of 12C-13C on Saturday and 14C on Sunday.

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What’s the difference between a bad period and endometriosis?

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What’s the difference between a bad period and endometriosis?

“By the point I was diagnosed with endometriosis after 17 years, it was in my lungs.” “I was ignored for nearly 20 years, and now I rely on crutches.” “My pain was dismissed for 27 years, until I needed a full hysterectomy and a stoma.”

If you follow women’s health, these kinds of stories will be, sadly, all too familiar. The process of getting help for heavy period or endometriosis symptoms is – often literally – painfully slow. Being diagnosed can take over a decade. There is no known cure. Doctors still aren’t even sure why endometriosis occurs, and scientific research suffers due to historic under-funding. This March is Endometriosis Awareness Month, but the condition is still widely characterised and dismissed as ‘just a bad period’.

“My periods were always really painful,” Dr Raj Arora, who is a GP and has endometriosis herself, told me on The Independent’s Well Enough podcast. “Every month, I’d be in bed with extreme pain. When I talk about it on social media, I’m always alarmed at how many women write back resonating with what I’ve experienced, with no idea that it could be endometriosis.”

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“Pain relief wouldn’t even touch it”

For Dr Raj, it took 11 years to get a diagnosis. She believes that her upbringing in a South Asian family, where her mother and grandmother would tell her period pain was normal, meant she didn’t even consider that something might be wrong for years. The expectation to just ‘get on with it’, paired with cultural stigma around discussing intimate health, pushed Dr Raj to ignore the distress signals screaming out from her body. She thought what she was experiencing was normal; she didn’t want to make a scene. The instinct to suppress her discomfort followed her into adulthood, too.

When she reminisces on her early career, the positive memories are clouded by consistent physical pain. “When I was a junior doctor doing surgical placement, I’d be in the theatre at 6am, scrubbing in with my seniors and sweating from the cramps. I’d worry that I was going to be sick. Pain relief wouldn’t even touch it. Every time, I’d think: how am I going to get through this surgery?”

What is endometriosis?

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One misconception Dr Raj is passionate about fighting is that endometriosis is a gynaecological issue. Endometriosis is caused by the endometrium – the cells which line the uterus, thickening and shedding over the menstrual cycle – developing on other organs, like the ovaries or the bowel. When endometrial tissue spreads in these areas, it can’t shed as it is meant to and, instead, remains inside the body. This can cause chronic inflammation, leading to scar tissue on the organs which can cause them to ‘stick’ together.

Dr Raj Arora on the Well Enough podcast with Emilie Lavinia
Dr Raj Arora on the Well Enough podcast with Emilie Lavinia (The Independent)

What are the symptoms of endometriosis?

The most common symptoms of endometriosis are:

• heavy periods (which the NHS defines as ‘when you need to change your pads or tampons every 1 to 2 hours, or bleed through your clothes,’)

• severe period pain

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• pelvic (lower stomach and back) pain

• bowel and bladder pain or dysfunction

• fatigue

For Dr Raj, the penny finally dropped when she decided to try for a baby. After having some trouble concieving, she and her husband went for tests, which revealed endometrioma, or a ‘chocolate cyst’ (a benign, blood-filled cyst) on Dr Raj’s ovary. She also learned that her left ovary was stuck down. Fortunately, she was able to have children despite her endometriosis – but many aren’t so lucky. Endometriosis often causes issues with fertility, but exactly why or how this happens is still not known.

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How to tell the difference between endometriosis and a bad period

The main indicator of a potential case of endometriosis is symptom severity. “Painful periods are key,” Dr Raj explains. “Now, periods can be uncomfortable, and that’s normal. You might have some cramping, some fatigue, some back pain. But with those symptoms, you can get on with day-to-day life.”

The moment to start paying closer attention is when ‘normal’ symptoms become overwhelming and disruptive. “With endometriosis, the pain is severe. The cramps are so strong that you can’t get out of bed, or they make you nauseous, or you’re sweating a lot.

“If you’re losing a lot of blood, that’s also important to note. If you’re bleeding through heavy-duty pads, or you’re seeing clots bigger than a 50 pence piece, those are things that could be signs of something abnormal.”

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What to do if you have symptoms

Going to speak to a GP about any health concerns is always the first step to take if something is becoming a concern. And once you get there, “if you ever feel that you’re not being listened to, please push and ask for a second opinion,” Dr Raj says emphatically. “Even if it’s in the same GP surgery. Still, go and see a different GP.”

But whenever possible, Dr Raj recommends arming yourself with relevant, valuable information before that first meeting with a doctor. A symptom diary not only provides more information to you about what’s happening with your body, but also lays out the patterns, triggers, symptoms and issues in a way that a GP can quickly assess.

“Make notes about: this is what’s happening every single month, this is how long my periods last, this is how much pain I’m having, this is how many pads I’m using. Having all that information at hand is really helpful, especially if you’re waiting for an appointment for a while.”

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The doctor also recommends making the most of the resources at hand. Dr Raj is an ambassador for Endometriosis UK, and highly recommends their menstrual helpline and symptom checker.

Endometriosis cure and treatment

There is no cure for endometriosis, but surgery or medications can help to treat symptoms. Surgery is typically performed with a keyhole surgery called a laparoscopy, in which a small incision is made in the stomach under general anaesthesia. Medications like the combined pill can also be used to help reduce the hormonal burden, which might be causing or adding to the condition. Heat therapy – like using a TEMS machine – is also recommended for pain management.

Dr Raj recommends these treatments for endometriosis, but also stresses the importance of lifestyle changes. “Diet and graded exercise were the biggest changes which helped me. I was never an athlete, and I’m always busy, but things like mindfulness, Pilates, Yoga, meditation, and breathing techniques really help to ground you and reduce pain perception. I take less pain relief now, as a result.”

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