Not enough time to clean. The ambulance services dirty little secret…

It seems such a shame that after the much-anticipated launch of Northern Ireland’s new Air Ambulance this month the service should find itself the subject of yet another negative article in the Irish News, this time regarding the condition of our road ambulances and stations.

The article reports on how a surprise visit by the Regulation and Quality Improvement Authority (RQIA) exposed a number of hygiene breaches in the two ambulance stations inspected, and more importantly in our ambulances. This will come as no surprise to frontline staff or indeed our managers – they have been acutely aware of the underlying issues for some time and will only be spurred into action as a result of this report and associated media coverage despite staff raising concerns over the past 2 years.

Our infection control policy is comprehensive and throughout the document it emphasises how we have a personal and professional responsibility to keep the highest possible hygiene standards to ensure a clean, safe working environment for both staff and above all, our patients. Failure to comply is, quite rightly, a potential disciplinary issue. However NIAS are failing in their corporate responsibility to provide the cleanest, safest environment for staff and patients by not allowing crews to clean vehicles in accordance with their own policy, knowingly putting patient health at risk and only now instituting remedial action due to this surprise inspection and subsequent negative press.

If proper procedure is followed, each ambulance should be cleaned by two staff once a week, inside and out, over a period of 2 hours. In the past two years I can only remember being stood-down to clean an ambulance THREE times and I am certainly not alone.  Due to the pressures on the service it is increasingly more difficult to stand down an emergency crew for 2 hours to undertake cleaning duties but operational requirements surely need to be offset by the need to keep ambulances clean and patients safe.

The cleaning of vehicles is logged by control, so managers definitely know the scale of the problem but have so far chosen to keep dirty ambulances on the road and compromise patient safety rather than finding another way of keeping our ambulances clean. We can clean our trolleys after every patient has been handed over but we have to resort to spot-cleaning whenever we have a spillage that comes in contact with the interior of the ambulance. Given the obvious nature of these spillages this is far from acceptable.

We are glad that the issue is now being heard in the public domain, all we ask for is a safe, clean environment for staff and patients. It is extremely frustrating to have had our concerns and complaints ignored on yet another vital issue, only to see action because of a surprise inspection and media whistle-blowing. How many other problems could be avoided if managers just listened to staff?

The Ambulance Service should be ashamed to fail on this very basic level of patient care. The first rule of medicine is “primum non nocere” – first, do no harm. The most basic way we can achieve this is by providing a clean, safe patient area. Not allowing crews the time to clean is harming patients and further eroding trust in the service.

If just one patient acquires an infection as a result of our treatment it is too many. We also have to think of staff welfare, especially in the context of our abnormally high sickness levels. I have just finished a run of four extremely busy 12-hour shifts. I never finished on time, and on 3 of these days I did not get a break until the 9th hour of the shift. I am now home, exhausted and with diarrhoea. The combination of over-worked, run-down staff and dirty ambulances is a recipe for disaster and is bound to also affect patients and our families.

As I watched the news coverage of our new Air Ambulance being launched at the start of this month I was more than a little bemused at the spectacle of politicians and headquarters staff as they  jostled for position next to the shiny new helicopter, eager to be associated with our sexy new trauma service. It is depressing to see the enthusiasm and energy directed into a helicopter when our managers can’t ensure the most basic level of cleanliness in an ambulance.

The Air Ambulance was a breath of fresh air, a positive news story for once. We do not want to see any more negative press coverage about the service. The recurrent theme through all my articles has been on the need for staff engagement. We are really encouraged by the approach of our new Chief Executive but have yet to see much positive interaction with our managers. Let’s start listening to staff, acting on their concerns and above all, keeping patients and staff safe.

The post was written by a serving paramedic.


  • I hope that the management are disciplined, but they always seem very touchy about disciplinary policies.

  • Brian O’Neill

    Management listening to staff? It’s a revolutionary idea but it just might work.

    Why not just have cleaning crews to clean the ambulances when the paramedic are on their breaks?

  • whatif1984true

    Am I missing something but surely all these staff,who knew about the problem, had to do was drop a note to the RQIA and they would have inspected sooner and spurred management into action. Unless of course this had been done and the RQIA ignored it.
    We SHOULD be told the truth about this.
    Too often we hear of bad practices and problems bring tacitedly accepted too quickly by people who know about them.

  • Zeno

    The Health Service has changed. It has changed in my lifetime from being a caring service operated by people with genuine concerns for Patients. The priority now is hitting targets. I’m not sure when it happened. There is a theory that it started when Nursing was made a Degree Course. My theory is it must have happened before this and the people who decided that being a Nurse required a University Education also introduced KPI style management. That’s when it all went wrong.

  • whatif1984true

    I doubt that. Does anyone believe that public bodies record the bad management of managers and ACTIVELY use it to halt their promotion upwards. Ask any civil servant, no one gets sacked just moved. Its like the churches and child abuse.

  • William Kinmont

    As an emergency responder the crews need to know exactly where everything is and hasnt been altered.Also i imagine if their breaks occur at all they will be very sporadic in nature so not easily co ordinated.

  • Zorin001

    KPI’s have their place but it’s all to easy to become slave to targets. Also that it’s seen as a virtue to run all public sector organisations like the private sector whether it’s a good fit or not.

  • William Kinmont

    are there any examples of KPIs being applied to senior civil servants?

  • Zeno

    I know KPI well and I know that people have worked out how to scam the system. I know a guy who worked in a call centre and his personal target was to have a day where he didn’t take a single call. He did achieve it and got a promotion offer.

  • William Kinmont

    kpi s have been introduced to part of my industry .There used to be those who were good at their job and some who were poor . largely now we have the sharp operators who can beat the system. The system is having to alter the KPIs almost constantly in order to catch up thus now any genuine people left are dropping out. Only those who have whole departments in place dedicated to beating the kpis remain.

  • Zeno

    I agree with you completely. KPI removed real Managers who were able to manage and motivate a workforce. KPI works on the assumption that everyone is stupid.

  • Zeno

    I’d be shocked. KPI is only for the workers. Not the big boys. There used to be a blog I followed by CityBoy who worked in the Financial Services sector in London. He said that the big boys kids ,even the thick ones got jobs in the City on like 100k a year and were stuck in somewhere they could do no real damage. Can you even imagine those guys being on KPI?

  • William Kinmont

    TBH their welcome to it 100k to sit in a city office in a suit. I get to wear jeans and trainers to work often for 10 plus hours a day/night in the countryside and am genuinely happy at least 90 percent of the time.

  • William Kinmont

    yes KPIs are managed by an email address to the KPI contract managers secretary. Previously i was managed by an actual human lady who I could actually talk to . She could certainly let me know who was in charge but at the same time when abnormal situations arose and needed solutions she was practicle.

  • Oggins

    I don’t think it’s the KPIs that are the issue. I would say I the maturity of the management.

    I agree with William there are plenty of people playing the game, but that would happen, even if there was no KPIs.

    I use to work at a business where KPIs were altered to suit the narrative. This message came informally from central and above. Ultimately all their bonuses depended on it, so let’s alter it.

    The first guest of any KPI should be what is its output. What valve will it add?

    I have just got rid of a pile of KPIs because all it was doing was driving a poor lady mad to pull together a monster report, that to be frank, did nothing. No one battered an eye lid at it, because it added no valve or no one knew what to take from it.

    Really measurement should focus on the process and implementation of the process. If that is set up right then the right figures should be produced.

    Poorly thought KPIs are driven by poor management, who believe that they need to have flashy KPIs because everyone else has them.

  • Alan Murray

    I don’t know what the author was, but s/he was not an ambulance driver. A registered paramedic perhaps, or an emergency medical technician. Ask anyone in the emergency ambulance service how they feel about being called ‘ambulance drivers’ and be prepared for the answer.

  • Alan Murray

    That’s how it’s done in many UK ambulance trusts. It’s called ‘make ready’.

  • Zeno
  • Brian O’Neill

    You are completely right. I have changed the text.

  • Brian O’Neill

    Can you expand on this William? It would make an interesting post if you want to give it a go. You can email me on