Ambulances may be spreading infections such as MRSA because they are not being cleaned properly, union leaders warn.

...At the other end of the scale London Ambulance Service has introduced on-site cleaners who work throughout the night to routinely deep clean the fleet. They also restock ambulances with fresh kit, freeing up paramedics for seeing patients. Effectively, crews bring in a dirty vehicle and leave with a cleaned one, Unison said.

It is pretty good in London to be completely honest. The 'Make-ready' crews do clean the ambulances and they do have an attempt at stocking the ambulances. Except when there isn't the spare kit on the station, in which case they don't run around to other stations to try and find the equipment, that's up to us.

We are also still supposed to check the ambulances, but this rarely happens (unless you come into work early) as our call rate is so high.

There are also random swabs of ambulances where we see if there is anything growing on an ambulance that shouldn't be there. So far the results have been very good.

It's especially good considering that the Make-ready people get paid minimum wage and work hours like 1am-5am.

Where it is somewhat let down is that due to the desire to have us rapidly 'turn around' at hospital, unless there is specific soiling of the ambulance (blood, vomit, or for me last night, large amounts of spittle) we don't have the time to clean down the trollies with detergent.

Nor do we have enough blankets to have each patient have their own separate one - again they only tend to get changed if there is visible soiling or if the patient is known to be carrying a communicable disease.

But on the whole I think that we do a pretty good job with the resources that we have - we could do better, but that would mean that the government would have to give us more money. Something that they are loathe to do.

My crewmate and I were called to a nursing home not far from station. We'd already been warned that there was another ambulance crew on scene dealing with another patient.

We jokingly wondered if the nurses there were beating the patients up.

As we entered the home we were met at the front door by a member of staff (as any regular reader of this blog will realise, this is a rarity). It turned out to be the nursing home's manager. She led us towards the patient.

She also knew about the patient, even though he was only staying there for a week or so while his wife was in hospital herself. Again, a rarity.

As we stepped into the lift we met the other ambulance crew on their way out with their own patient - he told me that he'd had a look at our patient and that, while he had a cut to the head, he was otherwise fine. He also mentioned that it would be a shame to drag the patient out to the hospital.

Our patient was suffering from severe dementia and was described as 'a wanderer'. While wandering he'd had a simple trip and had hit his head against one of those bits of furniture that seem to dislike old people. He was currently sitting in a chair in one of the communal rooms, surrounded by another twenty or so deeply demented, and wandering, patients.

But here is the thing - the patients were all clean, their clothes were tidy and none of them were 'tied down*' to the chairs. There were also four nurses in the room engaging with the patients (even as one of them decided to have a root through our kit bag - and then started swearing at the nurse who told her that the bag didn't belong to her).

So it was obvious that this was one of those good nursing homes that I always believed was out there but seldom witness.

A bit like the Loch Ness Monster.

The cut to the patient's head was pretty typical - it had stopped bleeding and was a minor affair. To drag this demented patient out to the hospital would be rather cruel, so we decided to follow an 'alternative care pathway'.

"Alternative care pathway" is classic NHS gobbledegook jargon for 'the patient doesn't need to go to hospital'.

Instead we decided to call our Emergency Care Practitioner out to see the patient. The ECP is trained to deal with minor wounds and is on hand to see patients in their home. I knew who was working and like all the ECPs on our patch I think he's excellent and would be happy to have him look after my mum.

I have an advantage as, being an ex-A&E nurse, I'm pretty good at knowing what the hospital treatment would be. If the patient were to go to hospital the doctor there would treat him in exactly the same way as our ECP. Except that our ECP would do it better as it's easier to fire an ECP for doing something wrong than it is to fire a doctor.

We met the ECP later in the day. "You rotten sods", he told us, "I went to that patient - he was so confused he kept trying to hit me. Then he tried to bite me. I closed the wound with some glue, but nearly glued my glove to his head".

It all worked out in everyone's best interest - the patient wouldn't have to sit for hours in a loud and confusing A&E department getting scared out of his wits and being put in danger of injuring himself again. The hospital wouldn't have that extra patient to see. We were able to clear the scene quicker and were able to go to a more serious call after dealing with the patient - without the ECP we would have still been tied up with transporting him. The nursing home wouldn't have to send a nurse to accompany the patient, thereby reducing the care cover.

And the ECP got to lose a wrestling match with a frail 90 year old man - which is always good for the ego...

*Not literally tied down (although I'm sure that it does happen). But instead patients are hemmed in by trolleys, chairs or other bits of furniture in order to stop them wandering.

If this post makes even less sense than normal please accept my apologies - I've just come off a tiring nightshift and haven't had the chance to sleep yet. I just want to stumble around moaning "Brains... brains...."