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Cancer: 'Half Of Doctors Failing Patients'

Written By Unknown on Sabtu, 07 Desember 2013 | 23.17

Family doctors have been accused of failing cancer sufferers after new data suggested more than half are not referring patients to specialists quickly enough.

Figures from around 4,000 GP practices in England show that, in many cases, only a minority of patients are fast-tracked for investigation by a specialist.

In some practices, only around 10% of patients eventually diagnosed with the disease saw a specialist within two weeks.

The target for the NHS says 95% of patients with suspected cancer referred by their GP must be seen by a specialist within two weeks.

While some GP practices show 100% of patients with cancer making it through the fast-track system, others fall far behind.

In around half of the practices in the sample, fewer than 50% of cancer patients were seen through the two-week system.

Not all patients with cancer visit their GP with symptoms.

Some are diagnosed in A&E, while others have cancer detected during routine tests, or are referred straight to A&E by their GPs because their symptoms are so bad.

Stuart Barber, head of communications and campaigns at Beating Bowel Cancer, said the findings were "intolerable".

151113 SUNRISE JEREMY HUNT Jeremy Hunt calls for action to tackle an 'unacceptable' postcode lottery

He said: "GPs have the tools. There are clear symptoms, there is a clear screening programme and if a patient visits their doctor with what are symptoms of bowel cancer they should have the confidence they are going to be referred quickly."

Health Secretary Jeremy Hunt called for tough action to tackle an "unacceptable" postcode lottery in the care being given to patients with life-threatening illnesses.

He said: "Every single patient in the NHS has a right to the very best care - and to see a GP who can spot cancer symptoms early enough to make a difference.

"That's why we've introduced a rigorous new inspection regime for GP surgeries to tackle this unacceptable variation across the country.

"The new chief inspector will speak up for patients without fear or favour, rating each surgery so we can celebrate the best practices and take tough action where standards aren't up to scratch."

The new data has been published by NHS England as part of a raft of information to help patients work out how well their GP practice is performing.

Mike Bewick, deputy medical director at NHS England, said the level of variation between practices is too wide.

He said the data offered an "important insight for commissioners as to where we should be doing better".

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Man Admits Strangling Ex-Girlfriend And Baby

A violent partner has admitted strangling his ex-girlfriend and her seven-month-old baby boy in their beds two days after the couple separated.

Wesley Williams, appearing at Birmingham Crown Court, admitted the double-murder of Yvone Walsh, 25, and her seventh month old son Harrison at her home in Birmingham in June.

Yvonne Walsh Ms Walsh was found dead in her bed by detectives

University graduate Ms Walsh, from whom Williams had split two days before she was last seen alive in May, was found by officers in her bed and her baby son in his cot with the curtains drawn.

West Midlands Police described the murders as "shocking and senseless" and said they were unable to determine which of the two Williams had killed first.

Williams, 29, wearing a grey sweatshirt, spoke only to enter his guilty pleas to the two counts.

Judge William Davis QC told Williams he would be jailed for life and warned him to expect "a very substantial term" in prison.

He was sent to a secure facility following his arrest but after being assessed by mental health professionals he was deemed fit for interview after which he was charged with the murders.

Detective Chief Inspector Sarbjit Johal, from the homicide investigation team, said: "Wesley Williams has pleaded guilty to the shocking and senseless murders of his partner Yvonne and her baby Harrison who both had their whole lives ahead of them.

"Yvonne's family described her as a warm and loving person who was a dedicated professional and absolutely devoted to her two young children.

"My thoughts are with their family, friends and the community that they lived in who are all still struggling to come to terms with their deaths."

Williams will be sentenced next week.


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Police Woman Jailed For 'Burying' Rape Claim

A policewoman lied to an alleged rape victim by telling her that prosecution lawyers were unwilling to pursue her case.

PC Hannah Notley told the alleged victim, as well as her superiors, that the Crown Prosecution Service (CPS) had decided not to pursue her allegation of sexual assault, even though she had never passed the file to them in the first place.

The Essex Police sex assault specialist later tried to fob off the alleged victim by telling her the CPS had dropped the case because she had reported it too late.

A defence lawyer said the police officer was undergoing some sort of emotional breakdown at the time which led to her behaving as she did.

When the alleged victim was told her rape was not being looked into, she tried to take her own life.

Notley was jailed for four months on Friday at Southwark Crown Court, in London.

She had previously pleaded guilty to a charge of misconduct in public office between July 6 2011 and April 21 2012.

The 30-year-old, from Benfleet in Essex, wept throughout the sentencing hearing and broke down as she was sentenced, saying "I love you" to family members in the public gallery as she was led away.

Prosecutor Zoe Martin told the court that after Notley was assigned to the case in July 2011, the alleged perpetrator was arrested and interviewed, and his mobile phone and computer examined.

But when Notley was later asked what had happened in the case, she told a superior the CPS had decided not to pursue it.

When it was then logged on the police system as having "no further action", Notley failed to put superiors straight and even told the alleged victim herself that CPS lawyers had decided to drop the case, despite knowing it had never been passed to them.

In February last year, Notley spoke to the complainant, telling her that the CPS had dropped the case because she had reported it too late so there was no physical evidence.

Miss Martin said: "She (the complainant) was clearly upset because it implied that the NFA (no further action) decision to some extent was her fault for reporting the rape late in the day.

"The alleged victim states that on the evening that she was telephoned by Ms Notley to say that there was no further action, she tried to take her own life."

The matter only came to light after an independent adviser allocated to the complainant pursued the matter and it transpired that the CPS had never been sent the file.

The rape allegation was reinvestigated, the court heard, and the alleged perpetrator has now been charged. He is due to stand trial in May.

The court heard the woman had been left devastated by the revelation that Notley lied and it had ruined her trust in the police.

The explanation given to the court was that Notley had been suffering from difficulties in her personal life - she had split from her fiance just weeks before their wedding, and she had later suffered a miscarriage which coincided with her sister falling pregnant.

In mitigation, Allan Compton, on behalf of Notley, told the court she had been "beset with guilt" over her lie, but had not gained from it.

He said she had been deeply depressed at the time and had suffered some form of emotional breakdown, but it was never her intention to "bury this investigation completely".

Notley later lost her job with the force, the court heard.

An Essex Police spokesman said today: "We await the full detailed report of the IPCC investigation and will deal with any recommendations which are made."

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Norfolk Yachtsman Braves Surge To Save Boat

By Tom Parmenter, News Correspondent

While people retreated to their homes or evacuation centres one man rode out the biggest storm surge in a generation aboard his 26-foot sailing boat.

Dave Jones, from Wells-next-the-Sea, was moored up in the picturesque harbour at nearby Blakeney in north Norfolk.

As the sea levels rose 30 feet above their normal levels he stayed aboard his vessel named Kabeeni, with his anchors and lines straining against the powerful surge.

"This is my pride and joy I was going let it go without a fight. Yes I was nervous at times, well not nervous, terrified really."

Dave Jones on his boat While other boats were dumped onto the road, Mr Jones' vessel stayed put

Other boats in the harbour were dumped onto the road that runs through Blakeney while others just vanished from their moorings.

Dave's boat though survived relatively unscathed after he spent hours battling the elements to ensure it stayed tied down.

Below deck in his small cabin the 62-year-old grandfather prepared himself a hot jalfrezi curry to see him through the night.

He said: "I have always loved boats, and I love staying aboard them.

Watch live coverage of the UK floods on Sky News HD

"People were telling me I was mad but I thought no, I've got to fight for my boat."

Several homes and businesses were flooded around Blakeney harbour, but staying on top of the giant tide meant Mr Jones stayed dry.

He added: "I did have an escape plan, the little dinghy would get me out if it had got too much, but I persevered and won."

He is now planning to spend another night aboard, but the high tides are not predicted to reach the levels seen on Thursday night.


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Taser Used On Devon Special School Boy

A teenage boy with complex learning difficulties has been Tasered by police in the grounds of a special school.

Devon and Cornwall Police were called to Chelfham Senior School near Plymouth after reports of an alleged assault on a teacher.

The force confirmed officers deployed a Taser during the incident at 9.20pm on December 1, which involved three boys - a 15-year-old and two 14-year-olds - after reports that knives were brandished at officers.

But a solicitor has called into question the use of the device, in the circumstances.

Sophie Khan, a solicitor-advocate and legal director at Police Action Centre, said: "The police action may have been excessive.

"The use on children is only allowed if it is the only feasible method of restraining the child. It's only there if there are no other alternatives to restrain the child.

"Using a Taser on someone suffering some kind of behavioural difficulty or disability is something the policy or guidance doesn't allow."

The Independent Police Complaints Commission (IPCC) has not been contacted in relation to the incident at Chelfham, in Bere Alston.

The teacher was treated at the scene by paramedics for chest and head injuries before being taken to Derriford Hospital.

All three boys involved in the incident were jointly charged with affray and will appear at Plymouth Magistrates' Court on December 20.

The school, which specialises in children with learning difficulties including behavioural, emotional and social difficulties and autism, is owned by the exclusive Priory Group, a private company better known for its addiction clinics favoured by celebrities.

Devon and Cornwall Police are being investigated by the IPCC over a separate incident in which a man, who doused himself in petrol, burst into flames when he was shot with a Taser.

Andrew Pimlott, 32, suffered horrific injuries in the confrontation outside his house and died in a hospital burns unit five days later.

Figures released to Parliament earlier this year showed armed officers discharged, targeted or threatened to use Tasers against youngsters more than 320 times in 2011 - an 11-fold increase from the first year they were cleared for use against under-18s in 2007.

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World Cup 2014: England's Opponents Revealed

England have been drawn to play against Italy, Uruguay and Costa Rica in the 2014 World Cup in Brazil.

The draw means England's first game, against Italy on June 14, will kick off at 2am UK time in the city of Manaus, in the Amazon region.

They will face Uruguay five days later in Sao Paulo, before finishing their group match fixtures against Costa Rica in Belo Horizonte on June 24.

Roy Hodgson reacts to England's World Cup draw England manager Roy Hodgson reacts to the draw

England manager Roy Hodgson said: "Well, it's a tough group, there's no doubt about it.

"There's no doubt that with Uruguay and Italy, we almost got two number one seeds in our group, because Italy were very unlucky (not to be seeded).

"I'm not disappointed and having at least two of the tree games in places where the climate is more favourable for us is a positive.

"What climatic differences we'll face up there (in England's opening match, against Italy) will be the same for both teams."

Speaking ahead of the draw, Mr Hodgson had said Manaus was the one venue he was keen to miss out on.

"The tropical nature of Manaus is the problem," he said.

"Manaus is the place ideally to avoid and Porto Alegre is the place ideally to get."

The opening game of the competition will see hosts Brazil take on Croatia on June 12 in Sao Paulo.

Should England qualify from their group, they will face either Colombia, Greece, Ivory Coast or Japan in the second round.

The last time England faced either Uruguay, Costa Rica or Italy in the first round of the World Cup was in 1966 - the last and only time they have ever lifted the trophy.

Then, they played Uruguay in Group 1, drawing 0-0 at Wembley.

The groups in full:

Group A: Brazil, Croatia, Mexico, Cameroon

Group B: Spain, Netherlands, Chile, Australia

Group C: Colombia, Greece, Cote d'Ivoire, Japan

Group D: Uruguay, Costa Rica, England, Italy

Group E: Switzerland, Ecuador, France, Honduras

Group F: Argentina, Bosnia-Hercegovina, Iran, Nigeria

Group G: Germany, Portugal, Ghana, USA

Group H: Belgium, Algeria, Russia, Korea Republic


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Former Priest Questioned In Child Sex Probe

A retired Catholic priest has been questioned by detectives over the alleged sexual abuse of three schoolgirls between 1980 and 2000.

Canon Mortimer Stanley, 82, has been interviewed under caution by Greater Manchester Police following complaints from three women now aged 41, 35 and 21.

Canon Stanley is a former parish priest at St Vincent de Paul RC Church in Norden, Rochdale.

Police say the women were aged between eight and 10 when the alleged offences occurred between 1980 and 2000.

The women were schoolgirls at St Vincent's Primary School in Rochdale at the time of the alleged incidents.

However, police have confirmed that the offences did not occur at the school, but at an adjacent presbytery.

Detective Constable Christian Chivers, from Greater Manchester Police's Public Protection Investigation Unit, said the alleged incidents related to historical offences.

"I want to reassure local residents, and more importantly parents of children currently at St Vincent's, that these are historical incidents," he said.

"While we do not believe there is any reason for current pupils or their families to be unduly concerned, this is extremely serious and upsetting for the victims in this case, who we are continuing to provide specialist support to.

"The safeguarding of pupils is without doubt a top priority for us, the school and Salford Diocese and we are working together as part of this investigation.

"I am appealing to former pupils who may have information about the offences under investigation or who may want to speak to us about similar matters to come forward."

Anyone with information is asked to call police on 101, or Crimestoppers on 0800 555 111.

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Glasgow Helicopter Crash Pilot's Funeral Held

By David Blevins, Sky News Correspondent

The funeral has taken place of the pilot killed when his helicopter crashed onto a Glasgow bar last weekend.

Captain David Traill was one of nine people who died when the aircraft crashed on to the roof of the city's Clutha bar on Friday last week.

He was a decorated war veteran, having served in both Afghanistan and Iraq, but had flown for a private company since his retirement from the RAF.

Friends, family and colleagues attended a service at Glasgow University, led by chaplain Reverend Stuart MacQuarrie.

Before the memorial, a guard of honour was formed, with police officers on one side and air ambulance pilots and paramedics on the other.

The funeral cortege was led by police outriders and was joined by a friend of Capt Traill who rode his Harley Davidson motorcycle to the service.

The service had been put together by Capt. Traill's fiancee, Lucy, a graduate from the university, and his father, Iain, who sobbed as he read a poem, You Can Shed Tears, to mourners.

The minister read out a tribute from Lucy whom Capt Traill met just over four years ago.

She said: "Dave was the best thing that ever happened to me …He was the most amazing, caring, loving, strong, capable, funny, creative, delicious and sexy boy in the whole world and I cannot even begin to imagine life without him."

As daylight broke, the recovery process continued The helicopter crashed on the Clutha bar a week ago

She added that some of his passions included cycling, Scotland's west coast, fine dining, kayaking, Take That, and "best of all" karaoke.

"It all seemed too perfect but there was no catch. He just adored me and told me every single day," she said.

Mr Traill Snr read the same poem by David Harkins at his younger son Angus' funeral three years ago.

A close friend from Mr Traill's time in the RAF read a tribute to "the greatest friend a man could hope for".

Andy Rooney said: "David, Dave, Davey, Swampy - he was different things to different people and he touched many lives.

"But there was a consistency to him that few could match and many could envy. The calm he offered, the warmth with which he was received."

He went on: "He was the greatest friend a man could hope for. A steady, loyal brother in arms.

"He wasn't perfect, that would be tedious. He was a helicopter pilot who didn't like heights.

"You could get him in a helicopter, but you couldn't get him up a set of ladders. He was a pilot who got air sick, to be fair this was mostly on fixed-wing planes."

The 51-year-old had played an active role in the lives of his three young nephews since they lost their father - his younger brother Angus - to throat cancer three years ago.

Capt Traill did not make a mayday call before the aircraft crashed onto the Clutha bar, killing him and two police passengers: Kristy Nelis, 36, and Tony Collins, 43.

Six other people, attending a live music event inside the pub, also died: Robert Jenkins, 61, Mark O'Prey, 44, Colin Gibson, 33, John McGarrigle, 57, Gary Arthur, 48, and Samuel McGhee, 56.

Around 100 people were inside the building when the Eurocopter dropped out of the sky "like a stone" last Friday night and 10 of the 32 injured remain in hospital.

There was no black box data recorder on the helicopter but air accident investigators are examining the wreckage in Farnborough, Hampshire, and are expected to publish their initial findings next week.

Bond Air Services described their popular colleague as "the epitome of the consummate professional" and "a legend" whose passing would be mourned with "a sense of intense loss and sorrow".

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Air Traffic Control Problem Delays UK Flights

Flights at airports across the UK - including Heathrow and Gatwick - have been delayed or cancelled by an air traffic control system problem.

Thousands of passengers have seen their flights delayed by a problem switching from night-time to daytime operating capacity at southern England's main air traffic control centre in Swanwick, Hampshire.

Airports in the south east of England - the world's busiest airspace - have been hardest hit, with the knock-on impact disrupting flights across the UK and further afield.

Passengers have complained about a lack of information as they spend hours stuck on planes, while budget airline Ryanair has called for the Civil Aviation Authority to step in to prevent further chaos.

The National Air Traffic Control Service (Nats), which coordinates air traffic control across the UK, has said the technical problem will not be fixed until around 6pm.

A spokeswoman at Heathrow, where more than 200 flights have been cancelled, said: "Due to a technical issue with air traffic control, flights from many UK airports, including Heathrow, are subject to delay and cancellation.

"If you are flying today you should check the status of your flight with your airline. We are sorry that passengers have experienced disruption to their journeys."

Gatwick Airport tweeted: "Due to air traffic control systems issues some flights may be delayed. Please check with your airline."

NATS The problems stem from a technical issue at NATS air traffic control

There are also reports of delays at Stansted, Manchester, Cardiff, Southampton, Luton, London City and flights to the south from Edinburgh and Glasgow.

The issue has also affected flights UK-bound flights from Ireland and Europe.

British Airways said passengers on cancelled flights would be able to claim a full refund or be rebooked on alternative flights.

The airline said in a statement: "Given that Heathrow is the world's busiest two-runway airport and Gatwick is the world's busiest single-runway airport, there will be problems for all airlines as a result of the ATC failures."

A Ryanair spokesman said: "While we acknowledge problems can occur, where is the contingency? It's simply not good enough and the CAA needs to act now.

"Over 100 Ryanair flights to and from the south of England have been affected, with 10 cancelled so far. We apologise to affected passengers, however these circumstances are entirely beyond our control."

Dublin Airport tweeted: "Technical issue with air traffic control in southern England is causing a delay to some flights to England & continental Europe this AM."

Nats apologised for the backlog, blaming an internal phone system issue, and said it had handled 20% fewer flights than usual by midday on Saturday.

Queue at Heathrow Passengers queue to rebook tickets at Heathrow's Terminal 5

Operations director Juliet Kennedy told Sky News: "We are able to manage the levels of traffic we would normally see overnight perfectly safely but we're unable to open additional control positions at the moment, which results in a reduction in our ability to deal with busier traffic levels."

She said the military had given up airspace to make it easier for Nats to operate some flights while the technical problem persists.

Daisy McAndrew said she had been caught in the "unholy mess" at Gatwick as she tried to fly to Barcelona for work.

She told Sky News: "As ever, staff have been fantastic but they know nothing other than the fact it is going to be a very, very long delay - very frustrating.

"And also, it's embarrassing, isn't it? When you look around a lot of people on my plane are not British, they are flying British Airways, they are probably trying to get back to Spain and they will inevitably be thinking this is something that could have possibly been prevented.

"It doesn't show our air traffic control system or our travel system in a good light.

"I have never heard of an example where every single plane is grounded - it's quite eerie when I look out of the window to see the tarmac in Gatwick, normally so busy, and also the sky above Gatwick which is normally busy - completely static, there's nothing moving."

Mrs McAndrew said the pilot on her flight suggested the delays would cause problems at Heathrow for two or three days.

Image from on board a grounded flight Cabin crew opened the doors on a grounded flight as passengers milled about

Alwynne Gwilt, stuck at Stansted, told Sky: "We've just been stuck on the tarmac since we boarded the plane - at that point I don't think they realised quite the extent of the issue.

"Once we were settled in they told us there might be a delay of two hours and 45 minutes but we've had no updates since then.

"I understand that safety comes first. Unfortunately you want to make the most of it when you go away for a short getaway, but at the moment we're only seeing the yellow and blue of the Ryanair planes.

"You have to question why we had to get on the plane if they had known a little bit ahead of time. Now we're stuck with no tea, coffee, all those things you would be able to get if you were in an airport."

Take That singer Howard Donald was also caught up in the chaos.

He wrote on Twitter: "Control tower failure at Heathrow as left me stranded for 2-3 hours at dusseldorf. Anyone know any games besides eye spy?"

Radar engineer Dan Holland told Sky News the air traffic computer system runs at around 15% capacity during the night when there are fewer flights and then switches to near 100% during the day.

He said: "It seems that when they have made the switch something hasn't gone right and the data isn't being optimised enough for the safety of the passengers and the planes in UK airspace."

Sky News reporter Clare Fallon said problems at Swanwick had caused a similar backlog last summer.

She said: "There were several airports, mostly in the south of England, including Heathrow, and it took several hours then for them to actually deal with that problem."

Gatwick arrivals board The arrivals board at Gatwick Airport, which has been affected

Aviation analyst Chris Yates said passengers due to arrive at UK airports from overseas could find themselves diverted elsewhere.

He said: "There are contingency plans in place whenever this happens.

"Many of the long-haul flights, coming from China, India, the US and so on, passengers sitting on those planes may find themselves diverted to continental airports.

"But it's going to be a long wait for them. When the system kicks back in and starts working, there will be a backlog of flights.

Travel journalist Simon Calder said the technical glitch was a "disaster".

He told Sky News: "The south-east of England is the busiest airspace in the world. London handles far more passengers than anywhere else including Paris, New York, Tokyo and so on.

He explained that the lack of spare capacity at airports like Heathrow means things get "very messy, very quickly" and airlines are forced to cancel flights to create firebreaks, which allow the system to keep running.

He said there was "no way" that passenger safety would be compromised due to the ongoing problems but that airlines were facing losses of millions of pounds.

He added: "If you are flying today, then good luck, if you're only delayed you're in a pretty good place."

:: Are you stranded? Email us: news@sky.com.

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Weather: Tidal Surge Clean Up Under Way

By Emma Birchley, East Of England Correspondent

The task of cleaning and repairing flood-damaged homes is under way after a tidal surge so powerful it swept some houses into the waves.

The swollen sea flooded 1,400 properties across the country overnight on Thursday in coastal communities stretching from North Wales to Essex.

It was the most serious tidal surge to hit Britain for more than 60 years, and the Environment Agency said high tides on Saturday could cause more flooding in areas already inundated with water.

But the number of flood warnings and alerts has been reduced with fewer than 50 now in place, and no severe flood warnings, which are issued when flooding poses a "significant threat to life".

Susan Telford and Paul Citrine are still struggling to get through to their insurers after their home in Rhyl, north Wales, was left coated in mud once the waters receded.

Ms Telford said: "It's just a waiting game now, I suppose, and a long clean up...but we're lucky. We've got our health and we've got each other and material things can be replaced."

A man walks through the floods in Rhyl Flooding in Rhyl, north Wales

At Hemsby in Norfolk some homes are gone for good. The sheer power of the sea swept three over the sandy cliff and others were left teetering precariously.

Pub landlord Jonathan Thompson rallied his regulars to help save one family's belongings after he saw the cliff beginning to give way.

"It's heartbreaking to watch someone's entire life being swept into the sea never to be seen again," he said.

In Suffolk, police said there was no further threat from coastal flooding but local authorities warned that people should take precautions around floodwater.

These include preventing children from playing in flooded areas or with contaminated toys, discarding food grown in allotments or gardens and storing rubbish out of the reach of pests.

The Environment Agency says 800,000 properties were protected thanks to both permanent and temporary flood defences.

They helped prevent a disaster on the scale seen in 1953, when hundreds were killed.

But some barriers were breached as the tidal surge combined with high tides and strong winds.

People gather on a bridge in Sandwich, Kent, to watch the rising River Stour People watch rising waters in the River Stour in Sandwich, Kent

Speaking to Sky News in Boston, Environment Secretary Owen Paterson described the situation as "quite exceptional", expressing "deepest sympathies" to the people whose properties were flooded.

He said: "The water here was two feet over this wall, two feet higher than 1953, which was a real disaster when don't forget miles of farmland was flooded and tragically 307 people were killed."

He added that during the course of this parliament there would be more spent on flood defences than previously.

The Maritime and Coastguard Agency (MCA) said two women, two young babies in pushchairs and a dog had been rescued after being hit by a large wave at Louisa Bay in Broadstairs, Kent.

Thousands of homes in coastal areas were evacuated after officials warned that lives could be at risk.

Hundreds of people were forced to spend the night camped out in emergency rest centres.

The North Sea surge followed an Atlantic storm which brought severe gales of up to 80mph across Scotland and northern parts of England.

Some mountainous regions in Aberdeenshire and Inverness-shire reported speeds of around 140mph.

One man died after he was struck by a falling tree in a park in Retford in Nottinghamshire, while a lorry driver was killed when his HGV toppled onto a number of cars in West Lothian.

The adverse weather also caused chaos on the transport network, with rail services for Scotland and parts of the North of England suspended and number of flights disrupted.

:: Watch the latest live coverage from around the country on Sky 501, Virgin Media 602, Freesat 202, Freeview 82, Skynews.com and Sky News for iPad.


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