11 million people in the UK live with a long-term illness, impairment or disability. Over 90% of this group of people have a physical or cognitive issue that affects mobility, continence and/or physical co-ordination – issues that impairs their ability to undertake basic personal hygiene without the help of a carer.

Friends meeting in the park shaking hands

Statistics show households of a person with disability have a combined annual spending power of £249billion (Dept of Work & Pensions, 2019)

Figures released by Visit England show overnight trips made by, or accompanied by, someone with a health impairment or condition account for £2billion per annum. People with a disability account on average for 20% of a business’ customers.

They also reveal that 83% of people with a disability ‘walked away’ from inaccessible or unwelcoming businesses or made a conscious decision NOT to visit somewhere if they believed there were not suitable, clean toilet facilities for them.

The concept of a Changing Places toilet was developed from the need to accommodate people who need assistance from at least one carer, to enable them to access the community locally or further afield. Current ‘disabled’ (Document M type) toilets are often unsuitable, being too small, or not having appropriate equipment for people with complex needs.

Potential users of a wheelchair-accessible toilet with space, changing bench and hoist may include:

  • 1.2 million wheelchair users.¹
  • 6.5 million people who have bowel control problems.²
  • 1.5 million people with a learning disability.³
  • 1.2 million people living with stroke.4
  • The rising number of people with a limb amputation in the UK.5
  • The 1 in 400 children diagnosed with cerebral palsy every year.6
  • The 1.4 million people who are living with a brain injury in the UK.7
  • The 130,000 people who are living with multiple sclerosis.8
  • The 70,000 people with muscular dystrophies.9
  • 5,000 people with motor neurone disease.10
  • 50,000 people with spinal cord injuries, with approximately 1,200 new cases per year.11
  • The 1 in 500 people who have a stoma.12
  • The 10 million people who have arthritis or other, similar joint conditions.13

Building Regulations Approved Document M 2015

Toilet accommodation needs to be suitable and accessible, not only for people with a disability, but for all people who use the building.

Some people with a disability need to use a toilet more frequently than other users. The time needed to reach a wheelchair-accessible toilet should therefore be kept to a minimum when considering the location of unisex toilet accommodation. In large building developments, separate facilities for baby changing and an enlarged unisex toilet incorporating an adult changing table are desirable – a Hygiene Room or ‘Changing Places’ toilet (see over, BS8300-2:2018).


BS8300-2:2018 Design of an accessible and inclusive built environment.

The Standard sets down good practice for accessible building design in premises to which the public have access. It advises that people with a disability should be able to find and use suitable toilet accommodation no less easily than a person without a disability.

The time taken to reach a toilet is an essential element to be taken into account in its siting.

The Standard further recommends that any larger building where the public have access in numbers or where visitors might be expected to spend longer periods of time, should have a Changing Places facility.

The 2018 version has extended the remit of venues to which this applies specifically, to now also include large commercial retail premises. The list also includes educational, civic and public buildings, large hotels, tourist attractions, sport and leisure venues, shopping and town centres, transport hubs, motorway services, healthcare facilities, cultural centres.

A Changing Places toilet aims to meet the needs of people who have a personal assistant, and provides as a minimum:

  • Appropriate equipment i.e., a height-adjustable adult sized changing bench, height-adjustable wash basin, shower and shower seat and full room cover ceiling track hoist system.
  • Enough space, to enable manoeuvring for the disabled person and up to two carers, for a centrally located (peninsular) toilet with room either side for carers, and a screen or curtain to allow privacy.
  • A safe and clean environment, i.e., wide tear-off paper to cover the bench, a large waste bin and a non-slip floor.

Changing Places

A Changing Places toilet involves the creation of a larger, better equipped accessible toilet compared to Document M versions, which only address the needs of someone who can toilet unaided.

A Changing Places facility should be provided in addition to other wheelchair-accessible (Document M type) toilets. Each Changing Places toilet aims to meet the needs of people who need a carer to assist, and provides as a minimum:

  • The right equipment i.e., a height-adjustable adult-sized changing bench, height-adjustable wash basin to enable a safe working height for carers and meet the moving and handling requirements for the task, this will help to reduce the risk of any musculoskeletal related injury to carers or subsequent injury to the person being supported through unsafe moving and handling.
  • The room should also have an accessible shower and shower seat that is height adjustable to enable accessibility for users and also provides arm rests and a back rest for those that require support to maintain their own body and trunk position when using the shower seat, and full room cover overhead track hoist system to enable safe access to the toileting/bathing equipment/tasks.
  • Enough space, to enable manoeuvring for the person with disabilities and up to two carers, for a centrally located (peninsular) toilet with room either side for carers, and a screen or curtain to allow some privacy.
  • A safe and clean environment i.e., wide tear off paper to cover the bench, a large waste bin and a non-slip floor.
  • The room should be 3m x 4m, with a ceiling height of 2.4m.

In addition to the specialist equipment, standard accessible toilet features such as an emergency alarm and grab rails must be provided.

The British Standard notes that replacement of a conventional toilet with a wash and dry toilet can benefit users’ dignity and independence.

Changing Places facility

Example of fittings and accessories in a Changing Places facility.

Image showing a Palma Vita with fold-down support arms, height-adjustable wash hand basin, hoist, changing bench and privacy screen in a Changing Places facility.

Equality Act 2010

The Equality Act 2010 replaces the Disability Discrimination Act.

Under this legislation, service providers are required to make reasonable changes – including to the built environment – where a disabled customer or potential customer would otherwise be at a substantial disadvantage; previously, such changes were only required if it would have been impossible or unreasonably difficult for the person to access or use the service.

The Equality Act 2010 requires that service providers must think ahead and take steps to address barriers that impede someone with a disability. You should not wait until a person with disabilities experiences difficulties using a service.

Those changes should comply with the legal and ‘good practice’ guidelines outlined above.


1NHS England (2019), retrieved from: https://www.england.nhs.uk/wheelchair-services/#:~:text=There%20are%20currently%20around%201.2,of%20them%20are%20regular%20users (accessed on 31/01/2021).

2NHS England 2015, retrieved from: https://www.england.nhs.uk/blog/martin-mcshane-11/ (accessed on 31/01/2021).

3Mencap (2021), retrieved from: mencap.org.uk/learning-disability-explained/research-and-statistics/how-common-learning-disability (accessed on 21/01/2021).

4Stroke Association (2021), retrieved from: https://www.stroke.org.uk/ (accessed on 31/01/2021).

5Public Health England (2019), retrieved from: https://www.gov.uk/government/news/preventing-amputations-major-concern-as-diabetes-numbers-rise (accessed on 31/01/2021).

6Scope (2021), retrieved from: https://www.scope.org.uk/advice-and-support/cerebral-palsy-introduction/ (accessed on 31/01/2021).

7Barber et al (2019), retrieved from: https://commonslibrary.parliament.uk/research-briefings/cdp-2018-0145/ (accessed on 31/01/2021).

9NHS (2018), retrieved from: https://www.nhs.uk/conditions/muscular-dystrophy/#:~:text=Who’s%20affected%20by%20muscular%20dystrophy,UK%20at%20any%20one%20time.

10Motor Neurone Disease Association (2020), retrieved from: https://www.mndassociation.org/about-mnd/what-is-mnd/basic-facts-about-mnd/ (accessed on 31/01/2021).

11NHS England (2019), retrieved from: https://www.england.nhs.uk/publication/spinal-cord-injury-services-all-ages/ (accessed on 31/01/2021).

12Colostomy UK (2021), retrieved from: https://www.colostomyuk.org/information/what-is-a-stoma/#:~:text=People%20who%20have%20had%20stoma,ages%20can%20have%20a%20stoma (accessed on 31/01/2021).

13NHS (2018), retrieved from: https://www.nhs.uk/conditions/arthritis/ (accessed 31/01/2021).

Department of Work and Pensions (2019), retrieved from: https://www.gov.uk/government/statistics/households-below-average-income-199495-to-201718 (accessed on 31/01/2021).

To download this white paper – please click here