Are we becoming complacent about immunisaton

Posted at www.ilcuk.org.uk on November 16, 2011

Front page news in today’s Brighton Argus makes very worrying if depressingly predictable reading (Measles Sweeps Through Brighton and Hove (1)). The newspaper reports that “Nine children at two Hove schools have been diagnosed with the potentially fatal infectious disease in the past couple of weeks – more than the entire number of cases in the whole of Sussex last year.” It goes on to point out that some babies too young to be vaccinated have contracted the condition from other children.

What this issue isn’t however, is a just local problem for the people of Brighton. France has seen a very severe outbreak this year and a quick “google news” search highlights measles outbreaks in Canada, the United States (2), and New Zealand.

Just last week, the European Centre for Disease Prevention and Control (ECDC), highlighted “worrying signals” on epidemics of measles. Marc Sprenger, ECDC director argued that “The biggest threat we face is complacency about infectious diseases. The attitude that the battle against infectious diseases has been won must be continuously challenged,” (3)

In Brighton, authorities are responding by vaccinating children in schools. This is of course vital. Earlier this year the Health Protection Agency (HPA) urged parents to ensure that their children were vaccinated after a “tenfold increase in measles cases in the first four months of the year” (4)

It is easy to say after the event that children should have been vaccinated earlier. But what this outbreak does highlight is that despite warnings from the HPA, we may have taken our eye of the ball.

Over the last few years, ILC-UK has been studying and developing the case for adult immunisation. Through the ILC global alliance we have published reports (5) on the case for a life-course approach to vaccination. ILC-UK has developed thinking on how we could better deliver the flu vaccination to adults (6). ILC-UK also presented our thoughts on adult immunisation at European Health Forum Gastein earlier this year. (7) (8)

So, how does the measles outbreak among children fit in with our concerns about adult immunisation? At one level, it is important to note that measles occurs in adulthood as well as in children. It is also worth mentioning the importance of herd immunity (9).

But there are much bigger issues at play here and they are extremely worrying. The reality, as highlighted by ECDC, is that perhaps we are becoming complacent about immunisation.

Vaccination has a very positive story to tell, having controlled 12 major diseases (in many parts of the world). Other than clean water, it has probably had the biggest impact on mortality reduction and population growth.

Historically, we have “done” child immunisation very well in the UK. But we must ensure that as a result complacency doesn’t undermine progress. And we need to work across all vaccine preventable diseases to ensure that we not only continue to do child immunisation well, but that we improve it.

Alongside this, we must improve the way we deliver vaccination across the lifecourse. When the HPA made their warnings in May, their spokesperson, Dr Mary Ramsay, said “You’re never too old to get vaccinated” (4). Let’s hope we can find a way to better get this message out.

David Sinclair

1.http://www.theargus.co.uk/news/9366632.Measles_sweeps_through_Brighton_and_Hove/
2.There have been 220 cases of measles in the United States this year, the most since 1996 http://pediatrics.about.com/b/2011/11/13/dismay-at-measles-outbreaks.htm
3.http://ecdc.europa.eu/en/publications/Publications/1111_SUR_Annual_Epidemiological_Report_on_Communicable_Diseases_in_Europe.pdf
4.http://www.bbc.co.uk/news/health-13561766
5.See: http://www.ilc-alliance.org/book/life-course-vaccination-impact-life-course-vaccination-ageing-population.html and http://www.ilc-alliance.org/book/immunisation-not-just-kids.html
6.http://www.ilcuk.org.uk/files/pdf_pdf_190.pdf
7.Our slides from the European Health Forum Gastein can be found at http://www.slideshare.net/ILC-UK/optimising-adult-vaccination-in-europe
8.ILC-UK receives some (unrestricted) support from Amgen, Sanofi Pasteur MSD and Pfizer
9.http://en.wikipedia.org/wiki/Herd_immunity

Optimising Adult Vaccination in Europe

My presentation at Gastein in October 2011:

Optimising Adult Vaccination in Europe

View more presentations from ILC- UK.

Half Marathon's

Last week I ran the Great North Run. It was fun. And being my fifth competitive half marathon, it means I'm starting to get a bit of data to play with.

September 18th 2011. Great North Run. 2 hours 25 minutes, 21 seconds
February 20th 2011. Brighton Half. 2 hours 28 minutes, 44 seconds
September 26th 2010. Run to the Beast. 2 hours 40 minutes, 39 seconds
October 11th 2009. Royal Parks Foundation Half. 2 hours 35 minutes
February 22nd 2009. Brighton Half. 2 hours 24 minutes, 18 seconds.

So it turns it turns out that my fastest half marathon was my first one. But I am very pleased that this year I've managed to get close to my personal best. Had the Great North Run not been so crowded I am pretty sure I would have beat my personal best.

And here are my split times (km) below.

GNR2011 B2011 R2010 Parks09 B2009
Split Time Time Time Time Time
1 10:09 7:16 7:31 7:04 6:45
2 3:41 6:59 7:10 6:59 6:53
3 6:52 7:11 7:16 7:06 6:19
4 6:50 7:11 7:27 7:08 6:11
5 6:45 7:19 7:27 7:06 6:00
6 7:10 7:09 7:26 7:07 6:29
7 7:13 7:23 7:21 7:13 6:30
8 7:08 7:24 8:01 6:55 6:39
9 6:49 7:05 7:54 7:17 6:41
10 6:54 7:12 7:32 6:46 6:12
11 6:34 7:02 7:03 7:09 6:38
12 6:42 7:13 7:35 7:15 5:46
13 7:04 6:53 7:42 7:00 6:49
14 7:16 6:58 7:44 7:18 6:37
15 6:43 7:03 8:09 7:01 7:02
16 6:44 6:43 7:44 7:47 6:45
17 6:57 7:00 7:20 8:03 6:47
18 7:12 7:08 7:24 7:47 6:14
19 6:38 6:37 7:34 7:32 7:09
20 6:10 6:35 7:33 7:49 7:18
21 6:33 5:55 8:06 7:51 7:15
22 1:19 1:29 1:36 1:48 5:21

Next half marathon is in two weeks time. Royal Parks Foundation Half Marathon 2011. Just 3 weeks after the Great North Run. Am hoping to go under 2.25 mins UPDATE: I managed the 2011 Royal Parks Half Marathon in a personal best of 2 hours 21 minutes, 45 seconds Split 1 06:26.5 2 06:25.5 3 06:43.0 4 06:34.2 5 06:54.0 6 06:51.7 7 06:59.7 8 07:40.5 9 06:57.8 10 06:50.7 11 06:51.4 12 06:41.5 13 06:44.1 14 06:50.0 15 06:46.3 16 06:24.0 17 06:50.5 18 06:35.3 19 06:18.6 20 06:16.4 21 06:11.0

Housing, demographic change and the National Planning Policy Framework

In 2007, ILC-UK published “Sustainable Planning for Housing in an Ageing Population” (1). It pointed out that older households will represent half of all household growth to 2026, that one third of households were headed by somebody aged over 60, and that the 80 plus population would grow by one million from 2008 to 2025. It made a strong case for planning future housing supply based on demographic change.

Yet planning has become a very real barrier to creating the sort of housing our society needs. We cannot blame planning alone for the lack of affordable or appropriate new housing. But it has played its part.

There is already a major shortage of well-designed housing across all tenures and housing types to meet the demographic challenge ahead. The growth in the older population will accentuate the problem and the shortages will get worse. That is, unless the planning system, current or future, systematically addresses the significant growth in older households.

Yet fears that the English countryside will be tarmacked over has led to recent campaigns by the National Trust and some national newspapers against the Government’s new National Planning Policy Framework (NPPF).

The Government’s recognition that planning was becoming a barrier to economic development led them to propose a new NPPF which reduces the 1300 pages of current planning regulation to just 52. But despite being a relatively short paper, officials have managed to incorporate some very positive policies in terms of demographic change. The NPPF talks for example, of planning to promote healthy communities and the need to create a good quality built environment which will support health and wellbeing. Most importantly in the context of demographic change, it talks of the importance of meeting the needs of present and future generations. And it flags the role for inclusive design.

The most controversial part of the NPPF is the presumption in favour of sustainable development. Yet this is a proposal which makes sense. For too long, planners have been tasked with finding reasons to oppose developments rather than actually planning for a changing world. Planning is an extremely important profession. Yet it is one which has become too focused on tick boxes and finding reasons to oppose.

Of course, green space is important, not least to wellbeing. But the framework does maintain the need to comply with local plans. Localism will ensure communities still have significant planning power. The Presumption only comes into effect when a Local Plan is not in place. Where a Local Plan has been prepared, development must accord with its policies or be refused. This is empowering for local democracy.

The NPPF is a positive development. It is also the only game in town. The current system is a complicated and convoluted one to work with. It contributes to housing supply not meeting demand. If we fail to produce adequate aspirational retirement housing for older people, we will not free up stock of existing housing for future generations.

Of course the NPPF could be developed further and it could actually be stronger on demographic change and the links between health and housing. But Government must resist any changes which could damage the ability of our communities to meet the demographic challenge ahead.

1) http://www.ilcuk.org.uk/record.jsp?ID=25&type=publication

In September ILC-UK published “Establishing the Extra in Extra-Care” which set out the role for extra care housing in the context of demographic change. It highlighted how good quality specialist retirement housing is important for the health and wellbeing of the older population. http://www.ilcuk.org.uk/record.jsp?type=publication&ID=100

#scrambledegg at the Paragon Hotel in Birmingham

I was very excited (see http://davidasinclair.blogspot.com/2011/09/worlds-best-scrambled-egg.html) when I arrived at the breakfast station to discover scrambled egg which didnt look overcooked.

So excited that I rushed to get a plate and get some egg onto it before the flame under the egg added too much extra heat. In the dark of the room the egg looked perfect.

But that is where my joy ended. Whilst the egg didn't look overcooked, the light of my table revealed one of the worst scrambled egg sins. I'm pretty sure it was made with some sort of pre prepared mixture. And if it wasn't I really don't know how they have achieved such a bad result with real eggs. It wasn't the colour of egg (more white than yellow), the texture was weird (looked like it had been sliced), and it had no flavour at all.





Terrible. 1/10.

Location:Moseley St,Birmingham,United Kingdom

The world's best scrambled egg

Imagine my delight at coming down to breakfast and discovering scrambled eggs which didn't look overcooked.

You may not realise this but I strive for the prefect scrambled egg. Whether it be at home or in a hotel, I find myself becoming terribly grumpy at bad scrambled egg.

As you know, I am not a fussy eater and I hate waste. So far too often I clear a plate even if it's not particularly good. But my limit is scrambled egg. I simply can't eat bad scrambled egg.

This frequently causes familial issues where I end up cooking two lots of scrambled egg (some people insist on overcooked eggs). When family members have made me bad scrambled egg I come across as stuck-up for refusing to eat it.

So I'm delighted to launch today the first annual search for the best scrambled egg. I was going to limit my search to Britain but I will give the rest of the world a chance. That said, my experience of scrambled egg across mainland Europe is not a good one. Don't hold your hopes up Brussels.

To give a few tips for potential entrants, the most common mistake is that scrambled eggs are over-cooked. It's very easy to over cook scrambled eggs (even I sometimes do it so you can be forgiven). And hotel chains tend to deliver the worst examples. They frequently put overcooked scrambled eggs on a huge hotplate over a flame at 6 am. They are slowly cremated. That said, I've been to a couple of hotels which have done it well so it isn't impossible.

The ultimate crime against scrambled egg is to use some sort of fake egg mix to make it. It tastes and looks terrible. Don't do it.

Scrambled egg does need good seasoning. And it (probably- someone prove me wrong here) needs to be cooked using butter.

Scrambled egg often works well complemented with something like chilli or a tiny scraping of marmite. I personally prefer to under season and add the salt through marmite.

I'm after your nominations and I will try them out and report back. If you think you cook the best scrambled egg (at home, in a hotel or a restaurant) let me know and I will happily pop over to try it out. Do post your nominations below.

I will do this over the next 12 months so the deadline for entries is 20th September 2012. Which is my 38th birthday. On that morning I will return to the best provider and reward them with a homemade certificate. They will be so excited.

Give me your nominations below.

Location:Moseley St,Birmingham,United Kingdom

Council Tax Benefit reforms will pitch young against old, and poor against poor

The Welfare Reform Bill, currently passing through the House of Lords, has attracted much media attention this week. The decision to move the committee stages off the floor of the House and into a committee room has led to criticism that the debate on the bill is being ’squirreled away’[1].

The Bill will have a far reaching impact on all ages and it is vital that it gets a good hearing. It abolishes Council Tax Benefit and passes responsibility to local authorities to determine the support they give to low-income households to meet their council tax bills [2]. But local authorities must also deliver a 10 per cent cut in the total amount spent on Council Tax Benefit in their jurisdiction.

Pensioners, however, will be protected from this cut. The Government has said that it will do this by prescribing “the criteria, allowances and awards for council tax support to pensioners which local authorities will need to provide for in their local schemes”[3].

This policy represents a recipe for intergenerational conflict. It seems unjust that one group of the poor population will be treated differently to another. One implication is that if a charity were to run a take-up campaign – 3 million households do not claim the Council Tax Benefit they are entitled to [4] – to encourage older people to apply for the benefit for which they are entitled, they will be reducing the pot of money available for local authorities to fund support for other vulnerable groups. Pitching the poor against the poor is bad policy, and in this case, it will also pit young against old.

To an outsider it appears that the Government has watered down localism for political expediency. If the Government believes a reformed Council Tax Benefit system works better locally, then they should let local authorities manage the resources and not stipulate that any one group will be protected. Arguably this is merely a localism of political and fiscal convenience, not principle.

It is worth looking at the figures in more detail. Council Tax Benefit is actually the most popular means-tested benefit in terms of the number of recipients, that is, 5.8 million households. The benefit currently costs around £4.8 billion per year, with an average award of around £830 per year (it generally covers all of a household’s council tax bill) [5].

Almost half of recipients are households with occupants aged 60 or over, that is, 2.7 million people. There are 3.1 million working-age recipient households. We do not know the average awards for different age groups, but if we assume that households from different age groups receive roughly the same amount on average – which is a relatively safe assumption – this means that the required cut of £480 million must come entirely from the amount spent on working-age households. It would reduce the working-age bill to just under £2.3 billion, leading to an average award of around £735 per year, or a cut of around £95 per year.

This is not significantly more than the amount that would be cut if no groups were protected. But the fact that older households will have no cut means that based purely on their age, poorer older households will receive £95 more in Council Tax Benefit than poorer young households. This inequality will be exacerbated if council tax bills rise, yet the total amount that can be spent on Council Tax Benefit does not – a scenario which seems very likely. Older households could remain entitled to 100 per cent discounts as part of the pensioner protection, but working-age households would suffer a cut in the proportion of their bill that can be discounted, as well as a cut in the total amount received. The move to a locally administered and defined system will also undermine attempts to increase take-up as local authorities will receive no extra funds if take-up improves.

It is still the case that Council Tax bills in part of the country hit the asset rich, income poor very hard – older people are more likely to fall into this category. Moreover, around 1.3 million recipients are single female pensioners, who are especially susceptible to poverty. Yet 1.6 million working-age recipients have dependent children, and 1.1 million of these are lone parents. The age distribution of the impact of cuts remains unclear and there is no compelling argument why older people should be protected at the expense children and young people.

Of course, Council Tax Benefit reform is not the only aspect of the Bill which deserves attention through an intergenerational lens. For example, the social housing sector is extremely worried about the impact of Housing Benefit reform on the sustainability of some retirement housing options. This could have a knock-on impact on the housing market for all ages.

The Welfare Reform Bill is a very controversial one. In some ways, whether debate takes place on the floor of the House of Lords or in a committee room probably makes little difference. But what the Government must do is allow and encourage proper scrutiny. And intergenerational fairness must form part of this scrutiny.

Dr Craig Berry and David Sinclair

This blog was initially published at www.ilcuk.org.uk



1. http://www.guardian.co.uk/society/2011/sep/15/welfare-reform-bill-society-daily-email

2. For sake of clarity, Council Tax Benefit is not technically a benefit, but a reduction in the liability to pay tax

3. http://www.communities.gov.uk/documents/localgovernment/pdf/19510253.pdf

4. http://www.telegraph.co.uk/finance/personalfinance/7144127/16bn-worth-of-benefits-unclaimed-every-year.html

5. http://www.npi.org.uk/files/New%20Policy%20Institute/Council%20tax%20benefit%20briefing.pdf

Can a Big Society for all ages improve the reputation of our cities?

The summer riots across a number of English cities prompted Weber Shandwick to organise an event last week which explored the how the reputation of cities could be improved.

Increasing urbanisation is paradoxical. The seminar heard that cities have long been seen as crime ridden, dirty and dangerous (Charles Dickens is to blame apparently). And whilst they are perceived by many as good places to visit, the English seem to perceive that village life is more pleasant.

But cities exist for a reason. The exchange of ideas, cultures and experiences is far easier in a city than in a rural area. Cities drive economic growth. And despite the growth of social media, face to face contact is still extremely important.

Over the past 25-30 years the brand image of many UK cities has improved. Cities such as Manchester and Leeds have been transformed and London is playing a significant “World City” role. The seminar heard that whilst the reputation of UK cities is still not brilliant, they are improving.

But did the riots change all of this? For a couple of days across cities in England, people were afraid for their homes. In a world of 24 hour rolling news, cities and towns found themselves attracting the interest of a global audience.

Riots are not a new phenomenon. In fact one presenter pointed out that they might actually be “a necessary/inevitable evil of cities”. And we do forget about them quickly. Relatively recent riots in Paris are distant memories for many of us and the experience of them does not seem to have a long term impact on tourism.

One area of consensus in the seminar was that we don’t really know what caused the riots: “the reasons are complex” said at least three participants. Some cities, with similar characteristics to London, Birmingham and Manchester did not find themselves subject to riots. And certainly not all deprived communities saw rioting. There was an overwhelming view from delegates that the cause wasn’t spending cuts but long term and structural challenges. “Criminality, not cuts” argued one panel member.

The seminar heard slightly differing views as to the extent to which solutions lay in terms of the physical (buildings/built environment) or in terms of human capital. Some felt that “shiny buildings don’t improve the life chances of people without skills”, whilst others highlighted the importance of a good quality built environment in terms of engendering public pride. If people don't respect where they live they will trash it, argued one participant.

Government’s response to the people issue is, “Big Society”. And as one commentator pointed out, far more people were up cleaning the following day than rioting in the evening.

But ILC-UK research (1) by Dylan Kneale has highlighted significant challenges of engaging older people in the urban areas with the Big Society. The research found that those living in urban areas are less interested in politics and significantly less likely to vote in all or most local elections than those in rural areas, although much of his effect appeared driven by higher levels of disadvantage and inequality in urban areas.

The analysis of the British Social Attitudes Survey found that:
*Older people in urban areas were not as interested in politics – twice as many older people in urban areas said they had little or no interest in politics (35%) compared to older rural residents (18%).
*Not only were adults of all ages in urban areas less interested in politics, they were significantly less likely to vote in all or most local elections than those in rural areas.
*Older people in urban areas are significantly less likely to have access to the internet at home (two-fifths do) than older people in rural or suburban areas (over half do).

It’s not just about people of course. And the advocates for an improved investment in a better built environment have a strong case. Housman redesigned Paris to reduce crime for example. We are seeing increasing evidence of the case for lifetime neigbourhoods to deliver better built environment for all. The coalition Government must continue the previous Government’s work to ensure that the design of communities meets the needs of a changing demography. There is clearly a need for a long term strategy for the development of our built environment.

But as our research has highlighted, if Government is to engage Big Society in tackling the causes of the riots, they will need to invest in creating a more engaged urban community. People matter. We have to find a way of ensuring greater equality of engagement in urban areas.

One contributor to the seminar pointed out that far too often we look to Government to solve these societal ills (“do something”). There is undoubtedly a role for local and national government, but as the contributor concluded “The ‘doing something’ people should be all of us”.

David Sinclair

(This blog was also published at www.ilcuk.org.uk)

1) http://www.ilcuk.org.uk/record.jsp?type=news&ID=139

Weber Shandwick organised an event on “Restoring the Reputation of our Cities” on 7th September 2011. Speakers included: Andrew Carter, Director of Policy & Research, Centre for Cities; Chris Murray, Director, Core Cities; Tony Travers, Director of the Greater London group at the London School of Economics and Damian Wild, Editor, Estates Gazette.

Boiler rooms continue to cost the older consumer

The Times reported last week that “a new generation of ‘boiler rooms is cropping up overseas, stretching the ability of law enforcement agencies to stop them ripping off British Investors”.(1)

The term ‘boiler room’, is used to describe frauds in which sales people are hired to call unsuspecting individuals and push investment opportunities. These high-pressure calls are often used to sell worthless or nonexistent securities. These operations typically consist only of a large number of telephones in a single room, giving rise to their name.(2)

Boiler rooms represent a huge cost to the UK consumer. The FSA estimate that they cost the UK consumer £200 million a year.(3) And much of that cost falls on the older consumer. Six in ten of those exposed boiler rooms are aged over 45 and one in three (35%) over 65.(4)

Of course, not all older people are vulnerable consumers – and many are in fact more confident and experienced consumers. But as we get older, we are more likely to find ourselves vulnerable to scams, mis-selling and other consumer crimes. Research dating back to the 1970s suggests that older people may be ‘more easily persuaded and deceived, be less aware of unfair business practices, and have reduced information processing capabilities. (5) As a result, the research suggests this group more likely than other ages to find themselves vulnerable to consumer crime.

Recent years have seen a welcome increased interest from Government and police authorities on the issue of fraud. In 2005, and following a Manifesto commitment, the previous Government commissioned an interdepartmental review into the detection, investigation and prosecution of fraud. A review team comprising representatives from across the criminal justice system began work in October 2005 and the Fraud review was published in 2006.

Amongst other proposals in the review, the Government committed to setting up a National Fraud Strategic Authority to devise a national strategy for dealing with fraud and ensure that it is implemented. The review also proposed a new National Fraud Reporting Centre to tackle the problem of under-reporting and help enforcement officers identify trends and provide information to support investigations.

The National Fraud Strategic Authority (Now National Fraud Authority) was established in October 2008. And the Government has subsequently set up Action Fraud, as a single national place for individuals to report scams and frauds.

Since then, the FSA has worked with enforcement authorities to undertake a number of high profile enforcement actions. Six men and a woman were arrested, for example, in May 2009 for running illegal ‘boiler room’ share selling operations. The Financial Services Authority (FSA) said victims of the alleged fraud appeared to have lost £28m (6).

But whilst fraud has attracted much more attention in recent years, the perpetrators still seem to be ahead of the authorities. And despite the good progress over the past five years, there is much more that Government can do to tackle this challenge.

Alongside more research, more could be done to support victims of these crimes, who find there is very little (if anything) they can do about the losses they have suffered.

The multitude of bodies (OFT, FSA, NFA, SFO etc) tasked with working on this issue could still work better together. Alison McHaffie of Cameron McKenna is quoted in the Times as saying “Questions remain as to whether the present hotchpotch of overlapping jurisdictions is the best way to ensure these crooks are brought to justice”.(1)

There is also a need for greater interventions at an international level. There is a significant role for foreign governments (e.g. in Spain and Canada) in terms of tackling these crimes. In some countries little enforcement action happens because the perception of national agencies is that the victims are based in Britain, and the perpetrators, whilst based in their country, are also British. The responsibility then falls back onto British authorities who often have limited jurisdiction and powers.

Whilst some international cooperation exists, much more should be done to ensure criminals cannot exploit the lack of international cooperation to undertake fraudulent activities.

David Sinclair

(First published at www.ilcuk.org.uk)

1) Forget Costa Del Crime, boiler room fraudsters have eyes on rest of the world. The Times, Thursday 25th August
2) http://www.investorwords.com/517/boiler_room.html
3) http://uk.reuters.com/article/2011/08/22/uk-britain-financial-crime-idUKTRE77L4F220110822
4) http://www.fsa.gov.uk/pages/Library/Communication/PR/2009/055.shtml
5) Rosemary P. Ramsey, R; Marshall, G; Johnston, M; Deeter-Schmelz, D Ethical Ideologies and Older Consumer Perceptions of Unethical Sales Tactics Journal of Business Ethics (2007) 70:191–207
6) http://news.bbc.co.uk/1/hi/business/8035830.stm

Meatballs at Quality Chop House

When @georgedsinclair gets an idea into his head, he can be hard to persuade that it's a bad one. So from the moment two ladies stopped us on the corner of Exmouth Market, mentioning a new meatball restaurant, I knew we wouldn't be able to go elsewhere.

I like Exmouth Market. It's a nice area with some great restaurants and a nice vibe. It's also a shared space (road traffic and pedestrians the space). In effect it means that road traffic travels as slowly as pedestrians. It's also a relatively undiscovered bit of central London, not being particularly close to a tube line. (wiki link)

But I digress. We spent the weekend in the Holiday Inn on Kings Cross Road so it was just a stroll to Exmouth Market for tea on Saturday. And from the moment meatballs were mentioned I knew that would be where we were heading. 'I want meatballs', 'can we have meatballs?', 'Is this the meatballs restaurant?'....

I had mentioned to @shellsinclair the quality chop house on Farringdon Road but I couldn't see @georgedsinclair going for it. And I knew it was quite expensive. But we popped around the corner to look at the menu anyway, only to discover that the chop house was now the meatball restaurant (link).

So, bowing to the inevitable, we popped in. It was a good choice.

I had courgette meatballs in a curry sauce and @shellsinclair went for meatballs in a French Onion soup. Mr @georgedsinclair went for pork meatballs, partly because we thought these might be closest to the Ikea ones he loves (they weren't really). As sides we had some honey roasted carrots, Iceberg wedges with blue cheese and mash. It was all very very good, as well as being good value for money.

The place was child friendly and the staff had the good sense to ask if George wanted the sauce. He probably wouldn't have eaten them with if they hadn't.

For pudding I had a brownie ice cream sandwich. Again, very tasty. And george and I treated ourselves to milkshakes (strawberry and peanut butter respectively).

Meatballs at Quality Chop House is very good and I would certainly recommend. We went on the second day. The staff had too little to do which led to a slightly chaotic service. There was an eagerness to remove plates (done on two occasions before we had cleared them). They forgot the iceberg, and over the course we were served by pretty much every member of staff. But these issues will be sorted over time.

The meatballs were great. You must go.

Location:Rommany Rd,Lambeth,United Kingdom