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End the isolation caused by a lack of fully accessible public toilets

People with complex disabilities need Changing Places larger, better-equipped loos  

People with complex disabilities need Changing Places larger, better-equipped loos


Fear of not being able to use public toilets deters many people with complex disabilities
from leaving home. Picture: Alamy

Most of us don’t think twice about getting to a loo when we are in a public place, despite the fact that it isn’t always easy to find somewhere on the high street or when travelling, and the queues can be long.

However, for some people finding a loo that is accessible and suitable for their needs is nearly impossible.

More than a quarter of a million people, including people with profound and multiple learning disabilities, motor neurone disease, multiple sclerosis and cerebral palsy, as well as some older people, cannot use standard accessible public toilets.

The campaign’s aims

The Changing Places campaign, which began in 2006, aims to provide safe, fully accessible toilets to enable everyone to get out and about and enjoy the day-to-day activities most people take for granted.

A Changing Places toilet is one that has enough space for a person with disabilities and their carer, and suitable equipment including a hoist and a height-adjustable changing bench suitable for adults.


A toilet at Leicester Royal Infirmary, which offers users and carers plenty of space,
an adjustable changing bench and hoist. 


A similar facility at Heartlands Hospital in Birmingham. 

Since the millennium, almost 2,000 councils have closed public conveniences. Even those that haven’t rarely provide toilets suitable for people with complex disabilities. There is no law that compels councils to make such provision, and it is not surprising that such facilities are lost to cost cutting.

Many of us are able to depend on access to toilets in places where we go to shop or relax, such as supermarkets, pubs or hotels. But for some people, such as homeless people, those living in rural areas, and in particular people with a disability, access is much more fraught.

‘Without proper provision, we risk excluding large numbers of people. This is not only a human rights issue but a public health matter too’

‘Disability-friendly’ toilets are available, but they are not suitable for all types of disability. Although changing facilities for babies and small children are more common, for adults who require a changing space, the floor is almost invariably the only surface on offer.

How appalling that people in this position are forced to lie on filthy floors in tiny spaces so that their carer can help them to change a pad. How disgraceful that many public buildings, including healthcare premises, do not consider the needs of people who are unable to use any of the available toilets.

Broad support

At RCN congress last year, a resolution was passed to lobby local authorities to provide accessible public toilets catering for a broad range of needs. The college's bladder and bowel forum members have joined the member who proposed this important resolution and have spoken to parliamentarians, charities, other royal colleges and held a round-table discussion to find a way forward.

Without proper provision, we risk excluding large numbers of people. This is not only a human rights issue but a public health matter too. The fear of having an embarrassing accident because you can’t find a loo prevents many people from taking part in social or recreational activities. Social isolation and loneliness are known to lead to significant mental ill health.


This Changing Places toilet is in a pub in Wellington, Somerset. 

We need to jump up and down to ensure everyone is able to go out and about, knowing they will be able to find a suitable loo.

A number of supermarkets and larger high street chains are trying to address this, as are a few theatres, but if you need a Changing Places toilet, more often than not you cannot join your friends in the pub, the café, or the cinema. And you can’t go on a train or fly anywhere.

The RCN has joined the Changing Places campaign and we would urge all healthcare organisations and nurses to do the same.

We’re making progress

Fortunately, there are some signs of progress. There are more than 1,300 Changing Places toilets in the UK, up from just 140 in 2007. The Department of Health and Social Care has made £2 million available for acute NHS hospitals in England to install Changing Places toilets.

The government is running a consultation to change building regulations to increase the provision of Changing Places toilets in new, large buildings open to the public, as well as those undergoing building works. Please take part before the consultation closes on 21 July.

Join me and thousands of others in making a difference to the lives of people who need a Changing Places toilet.

Join the consultation


Amanda Cheesley is RCN professional lead for long-term conditions and end of life care

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