Why don’t NHS hospitals have accessible toilets?

Standard

Elderly man with a walking stick holding his hand up to his ear.

What’s that? Don’t talk rubbish. Of course the NHS have accessible toilets for disabled people in all of their hospitals. Don’t they?

You would think so, and yes they do have ‘accessible toilets’ that display the wheelchair symbol on them.  The problem is not many disabled people can easily use these toilets because of the nature of their impairment.

  1. some can’t use them at all
  2. many toilets don’t even meet the building regulations for sanitary provision known as Document M – and the basic regulations don’t cover people like me who have weakened arms and legs.

What if you can’t use the toilet?

Without my husband being present (taking time off work to assist me), I am one of around an estimated 230,000 people who can not use any of these toilets.

I either don’t go out or in the case of my health care appointments/emergencies – my husband must be present lifting/dragging me from my chair, onto the toilet, and propping me up so I don’t fall off. I can not stand or use my arms. It’s very scary, often dangerous for us both and undignified.

Building_reg_toiletThis is a cropped picture provided by building regulations outlining suitable toilets.

It has the outline of a wheelchair (a small sized chair) marked.

How on earth are 1-2 carers and a portable hoist supposed to fit into that space!  The outline of the wheelchair is also a lot smaller than mine (and I’m only a small adult!).

Even if you can stand or use your arms  – you would have to be pretty agile to get from your chair to the toilet independently. Yet as you will see later – this is the ‘standard’. Pretty unusable hey?

Things could be better…. a solution exists.

There are only 23 NHS hospitals in the UK where I can use the toilet, with my assistants.

They have what are known as ‘Changing Places’* – a toilet which has lots more space, a hoist, a changing table for adults and children, privacy curtain and sometimes automated washing and drying /bidet facilities to manage continence in a dignified manner.

*updated list of hospitals providing CP toilets at the end of this blog.

There are no Changing Places toilets in the hospitals I attend.

Many disabled children have to be manually carried/lifted and changed on the floor of toilets or find a free bed – because they do not provide changing tables other than for babies.

Dawn Kelleher describes her recent visit to the newly built Hospital for Children in Cardiff.

Guess what…. Nowhere to change my daughter. All they could offer was a consultants room and a commode with a cardboard pot! They’d never even heard of a changing places toilet. I’m fuming.

Rachel George explains:

I will not change my son on the floor of a public toilet. So we have found other ways, painstaking ways which are really difficult for us but keep him clean and safe from the germs and filth on the floor of a public toilet. My son cannot sit unaided or stand at all but he needs the toilet just like the rest of us.

On our recent trip to a hospital 200miles away for our 8 year old son’s first spinal rod lengthening procedure we had no option but to put him on the toilet in the back of our car. It is a physically difficult experience for us and not really dignified for our beautiful boy either.

 

If venues like zoos, stadiums, leisure centres, shopping centres, council buildings, railway stations, museums and even a pub and a few supermarkets can afford these facilities – then the NHS has no excuse.  You can see the full register here.

Lack of toilet and hygiene facilities should not be a barrier to health care and emergency treatment. It should not be a barrier to being employed by the NHS, volunteering at an NHS venue or a barrier to visiting or accompanying someone in hospital. This is a social and human rights issue thats needs legislation to resolve.

My blog below, highlights, through my experiences, the problems many people face – and the solutions which exist to provide accessible sanitary facilities for disabled people.

For more information about Changing Places visit http://www.changing-places.org

For petitions to improve toilet facilities you may want to consider signing Sarah’s Petition or Samantha Buck’s Petition or Tony Clough’s Petition


Using the toilet requires a lot of ability – do you have what it takes?

Let’s think about the strengths you need to be able to use the accessible toilet. It requires many actions of pulling, pushing, bending, grasping, reaching, twisting, flexing arms and legs, using fine motor control, core balance skills, coordination – and energy!

These are just some of the things you need to be able to do for this ‘simple’ task.

Ability to:

  • see where the toilet room is – and get to the door.
  • raise an arm (or equivalent) and grasp and pull the door open (perhaps against a strong spring), manoeuvre through the door, close it and manage the lock.
  • see where the toilet/sink/light switch is.
  • turn and position yourself (especially if you use a wheelchair, frame, cane etc).
  • move waste bins and other objects out of the way.
  • bend, grasp, lean and balance to successfully remove trousers / pants, lift skirts.
  • lift yourself out of your wheelchair and onto the toilet (or lower yourself down in a controlled and stable fashion if standing).
  • onto a grab rail (balance, grasp, extending arms/raising limbs) [and be able to pull down the grab rail if in the upright position].
  • balance (often for extended periods of time) to urinate/defecate
  • reach and grasp toilet role and twist/reach to wipe thoroughly
  • stand up or transfer back into your wheelchair, if used or reach for cane/frame etc.
  • maintain menstrual hygiene or change a sanitary towel or a soiled pad
  • get clothes back on
  • reach and push on a flush handle/button
  • turn on a tap, reach the sink if you haven’t already washed your hands/equipment.
  • manipulate soap and water to cleanse hands properly
  • hold hands in the air under a dryer.
  • see the door, open the lock and exit the toilet.

As you can see, vast numbers of people would find many of these tasks challenging.

So few people speak out.

old_manOver 12 million people in the UK have an impairment(s) which affect the senses, coordination, dexterity, grasp, mobility, strength, balance, cognitive understanding, continence and energy levels.

4 out of 100 adults (1 in 5 of women over the age of 40) have urinary incontinence and 1 in 10 people will experience bowel incontinence at some point in their lives.

Many of my friends with epilepsy, autism and mental health conditions also need to use these toilets – especially for the emergency cord provision.

Women in their last months of pregnancy also benefit from improved toilet provision.

A ‘standard’ accessible toilet is simply not suitable for so many people – but being about toilets and that taboo that still surrounds the need to pee, poo and menstruate, few people speak out about their dissatisfaction or difficulties – so things really need to change.

How I mange to use the toilet

So, here is what I need (and have at home) – is this too much to ask for?

  • I can’t walk – so I need a toilet space that is accessible in a powered wheelchair. 
  • I can’t stand up and my arms are weak – so I need to use a hoist to lift me out of my chair and onto the toilet.
  • I need space for an assistant to come in with me and help me use the equipment.
  • Also I don’t have much grip or body movement and have bowel incontinence – so ideally an automatic wash and dry toilet would be available for maximum dignity and cleanliness.

Such facilities exists – they are called ‘Changing Places’. They also have privacy screens, changing tables (useful for pad changes, self catheterisation,  or if you need to sit or lay somewhere else to remove clothing) and some have shower/cleaning facilities. Changing Places  shared this photo of an excellent facility at London Gatwick airport with automated toilet/washing/drying facilities.

Julie Clough and her mother Margaret at a CP toilet in London Gatwick.

 

How many NHS hospitals have these toilets facilities?

As of today, there are only 23 buildings in the UK which have changing places toilets for NHS patients, staff, volunteers and visitors who need these types of facilities on the register.

None of the hospitals or clinics I attend have any toilets I can use. I have listed NHS hospital who do have a CP toilet at the bottom of this blog.

Hospital Response

Accessible_Toilet_Sign-2I mailed each of the hospitals I attend and asked their PALS team what I should do if I need the loo, explaining my predicament.

This was their response, in summary.

  • Guys and St Thomas’, London

At first they didn’t understand and suggested my GP refer me to OT services, then when I further explained I had these facilities at home but needed to know what to do at the hospital. They contacted the Head of Buildings and Maintenance and thought that the staff caring for me at the hospital were responsible. They kept in touch and a few days later said they currently have no CP toilets but some are planned for in St Thomas’s. They offered to liaise with staff at Guys to make them aware of my needs.

  • Maidstone & Tunbridge Wells NHS Trust

Estates and Facilities were very unhelpful. They told me “power chair access to the toilet is permitted” and manual wheelchairs are on site to use. Toilets with regular seats (I asked for a toilet and not a commode) are situated in toilets compliant with the building regulations. Hoists are used on site but no offer of where they are, how to use them and what toilet they would fit into safely.

They felt that the standard accessible toilet was big enough for carers to assist in. They have no bidet/washing facilities to manage incontinence.

This response clearly shows a total lack of understanding about the needs of disabled people. I was appalled and dismayed as this is also my local A&E – if I am ill or injured, or my family are, I don’t want to have to be describing my toilet needs to someone and have to wait whilst they figure out a solution for every visit.

  • Royal Brompton & Harefield NHS Foundation Trust, London

Waiting for a more detailed response but they have been in touch and will look into arrangements for my appointment next year.

  • Oxford University Hospital Trust – no reply yet.

My current strategy

Currently, my husband has to take a day off work to come with me to all my hospital appointments. Many of them he would come to anyway – but not all. If he became ill or injured I could not attend any appointments because I would need the toilet – and there would be nowhere to go.

Currently we have to locate a toilet with enough space (not all accessible toilets have the same amount of space), and he has to lift me out of my chair and onto the toilet (stepping around sinks and other obstacles we can’t move out of the way).

I go to the Royal Brompton Hospital in London – for my respiratory check ups because I use a ventilator to breathe for me a lot of the time.

The toilets are a nightmare. There are lots of clinics with very sick or immobile people who desperately feed back to staff about the lack of shower and toilet facilities – only to be told (according to the notice board in the corridor) that the building is too old to change.

Well, I go to a clinic held in the shell of an old fire station – the inside was gutted and turned into a sleep clinic with an accessible toilet.

IMG_5290This is a modern building interior but still a very small space. I could barely turn around without hitting the wall or the sink and there is no horizontal grab rail on the left hand side. Luckily I lean to the right to prop myself up on the rails. In the other building the lack of grab rails on the right means we can’t use them at all. I have virtually no balance – sometimes I have had to lean over sanity towel bins to stay upright. Pretty disgusting.

You can also see the emergency cord is tied up – which is inconvenient if you have to then go out of the loo and find a member of staff to untie it. This is a common problem lots of people tell me about. We have to take off my tray, footplates and some clothing – there is no space to place it so I have to sit them on top of the bins or on the floor. Yuck.

 

 

IMG_6043As you can see, I can’t get right along side or 90 degrees to the toilet – popular positions for wheelchair users to do safe self-transfers.

My chair is as far back as I can go, blocking off the grab rail on the right hand side from coming down from the wall – so I have to lean on my wheelchair. My ventilator is also getting a bit squashed hanging on the back of my chair. My chair is only 2/3rd of the size of most power chairs – so they probably wouldn’t fit in at all.

As my husband lifts me, he has to drag me sideways and backwards to the toilet seat because of this layout – avoiding the sink that sticks out in front of the toilet (which he often hits his back on).

This is how we manage when outside of the house.

 

In the other building they do have a wash/shower room with space for a portable hoist – but the toilet is located between two walls (rather like a cubicle) so no room for assistants to get along side to help with positioning. You also have to go and find a hoist – it isn’t kept in the room so in theory someone else on the ward could be using it.  It’s also the only toilet room,  of this type, to serve many wards.  When each toilet trip can last 20-40 minutes – this can mean a long wait for other people – not good if you have urge incontinence or a dicky tummy!

We tried another toilet once – but the floor surface was very smooth, slippery and dangerous and we were told for health and safety reasons they couldn’t provide a non-slip mat to stand on!!!

Night from Hell

Basic_Commode_ChairI had to stay the night once and do a sleep study. I had explained that I couldn’t sit on a flat seat commode in advance  – but they provided no alternative. Because of my lack of muscle, my entire upper body rests on two bony ‘bits’  – part of my pelvic bones. The equivalent would be to get to you balance your body on your elbow points – on a hard surface. You would probably pass out after about 30 seconds as the nerve and bone pain is excruciating – so much so it is a method of torture in some countries. That is what I had to endure – twice, because the first time the pain was so bad I couldn’t empty my bladder. There I was, in agony, with my legs balanced on a suitcase for stability, torso hunched over my lap trying to pee. It was hell. I had pressure sore pain for weeks after.

Locally

Seeing my GP is also tricky – they were running over an hour late once and I was desperate for the loo by the time I got home. I nearly had to abandon my appointment as the urge was too much. Holding your bladder can give you pain, nausea, vomiting and heart palpitations and push urine back up into your kidneys. So, going to the GP could make me sick!

Essentially, without access to a toilet with a hoist in it, I can’t visit any NHS building with my assistants – unless I hold myself.

Solution

Disabled people have the right to be able to use the toilet in the manner that other people do – as and when the need arises, in a way that is hygienic, safe, dignified and as pain free as possible.

Not having suitable toilet facilities denies people access to routine and emergency healthcare.

We need legislation so that all NHS hospitals and treatment clinics can have a Changing Places Toilet with hygiene / cleaning facilities for anyone who can’t manage in a standard ‘accessible’ toilet.


If you found this blog insightful or helpful, please comment, like or let me know – thank you.


Locations of current toilets:

In England, the first hospital to have one was the Royal Hallamshire in Sheffield for patients, staff and visitors.

There are now toilets in (updated 22 May 2015):

Hospitals with a CP toilet

1 Barrhead Health and Medical Centre
2 Harold Wood Polyclinic
3 Ninewells Hospital and Medical School

4 Preston SMRC Specialist Mobility Rehabilitation Centre
5 Aberdeen Community Health and Care Village
6 Aberdeen Royal Infirmary
7 Addenbrookes Hospital
8 Blaydon Leisure and Primary Care Centre
9 Broadgreen University Hospital
10 Chorley & South Ribble District Hospital
11 Darlington Memorial Hospital
12 Dr Grays hospital
13 Finchley Memorial Hospital
14 Glen loch Centre, Whitehills Hospital
15 Great Ormond Street NHS Trust
16 Hornsea Cottage Hospital
17 James Cook University Hospital (The)
18 Leighton Hospital 
19 Lynebank wheelchair clinic, Lynebank Hospital
20 Norfolk and Norwich University Hospital NHS Foundation Trust
21 Northampton General Hospital
22 Nottingham University Hospitals NHS Trust, City Hospital
23 Nottingham University Hospitals NHS Trust, Queen’s Medical Centre
24 Royal Hallamshire Hospital
25 Royal Liverpool University Hospital
26 Sheffield Northern General hospital
27 South Bristol NHS Community Hospital
28 South Liverpool NHS Treatment Centre
29 Stafford Hospital
30 Trelawney Wing, Royal Cornwall Hospital
31 University Hospital Wales
32 Victoria Hospital, Fife
33 Woodend Hospital
34 York Hospital
 
Not a full CP toilet but either a hoist or bench provided.
 
  1. Diana Princess of Wales Hospital, Grimsby (Bench and hoist) in Assisted Living Project
  2. Sheffield Children’s Hospital (Bench and hoist)
  3. London Everlina Children’s Hospital (Bench and hoist)
  4. West Kent Wheelchair Clinic, Cox Heath (portable hoist and large space)
  5. South mead Hospital, Bristol (is this the same as South Bristol?) (Bench and hoist)
Due in the next year or future
  1. St Thomas’, London
  2. Cardiff Heath Hospital
  3. Norton Hospital, Swansea
Discontinued or plans fell through
  1. Wrexham Maelor, North Wales?
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10 thoughts on “Why don’t NHS hospitals have accessible toilets?

  1. In my own recent experience, there were plenty of accessible bathrooms but this was at the new Queen Elizabeth Hospital in Birmingham. As far as I could tell, perfect. Lovely facility.

  2. I don’t know about provisions at my local hospital as I haven’t had to stay in since my disabilities have got to the point where I need to use an accessible toilet. I do know that my local shopping centre has a CP toilet and my local college has one that has all the features of one but can’t be listed as it’s not for public use. It does get to me however that there isn’t a requirement for toilets, especially disabled toilets, to provide hand-drying facilities for those of us that can’t use hand-dryers, in my case due to sensitivities related to my aspergers syndrome.

  3. Excellent review. Looks like the Americans with Disabilities Act has had more impact than I realized in the U.S. (1990 & revised in 2009). But you should see how crazy low the toilet paper dispensers are with access generally at the bottom and about 18 inches from the floor! Overall the changes have helped. Julie, O.T.

  4. Anonymous

    The new hospital at southmead has a big disabled changing room with hoist facilities in the Brunel Building which is the new wards and outpatients on the ground floor

  5. A very insightful blog. I nowhere near have the same needs as you do and I get frustrated and annoyed about unsuitable provision that I experience, I can’t even begin to imagine what you go through. I was shocked at the number of hospitals that have a CP toilet, more so shocked at the number that don’t!

  6. Weirdly, there seems to be an expectation that anyone who is affected in both legs and arms is incontinent and that, unlike babies, they for some reason do not require regular changing and can instead just sit in soiled pads until it’s convenient.

    I thought you might appreciate both the humour and the horror of two NHS hospital toilets I photographed, both of which are the marked and designated accessible toilets. I’m blown away still! (Facebook account/login not required to view)


  7. My son has been paraplegic since around summer 2014, he uses a powered wheelchair, self catheterises and has bowel incontinence. His upper body posture is weak and he suffers from tremors in and off. He is 17, on steroids and weighs about 65kg. There is no way I could lift him or he could support himself so we don’t go out much. I am appalled by the lack of facilities wherever we dare to go.

    There is a changing room at Royal Manchester Children’s Hospital in the out patients on the ground floor. It’s ok but no wet/dry toilet. We attend the Christie – the leading cancer centre in the north west – no changing place! We’ve been going here so regularly in the last 18 months and so many staff know my son that we can arrange a side room or ward bed if he has an accident, but it’s always a situation that makes me feel like I’m asking for the moon.

    I’d love to help make a change. Think I’ll write to all our hospitals too!

    Wishing you all the best xxxx

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