Great to hear that at least in London the ambulances are getting cleaner. Here's an idea that might improve things though. Have make ready crews at some of the busier A&Es. So while you guys take the patient in and do hand over etc... they wipe down the trolley, replace blankets, top up kit stocks, refill any thermos mugs in the cab ;) Sadly it means more money... but it would surely mean less time out of action at the end of a job and cleaner ambulances...