Effort put into caring for equipment keeps it working properly and reduces unexpected failures and breakdowns. It also improves patient safety and continuity of clinical care. Clinical end users and managers often assume that the best way to look after medical equipment is to take out a manufacturer’s comprehensive service contract and renew it promptly each year. In many cases, this is certainly effective and can provide peace of mind. It is however not always the cheapest, most appropriate or even the most effective way to support equipment and reduce downtime. Active management of equipment maintenance leads to substantial economies and also improves service quality, by decreasing equipment downtime and reducing the risks associated with equipment failure or malfunction. This is achieved by mixing three elements – manufacturer servicing, independent or third-party maintenance provision and support from suitably equipped in-house engineering services – in an evidence-based approach.