The number of young people with disabilities has increased by 62% in the past 25 years. One young person in 20 under the age of 16 is disabled. Some 60% of statemented children are now in mainstream schooling. Over 20,000 students have a disability – almost 10% of the student population.
According to research by the Bog Standard campaign for better school toilets, 57% of schools surveyed did not have any disabled toilets. A study has found 1,600 pupils over 5 have toileting and continence difficulties.
Students with toileting and continence difficulties often require physical support with the toileting process, as part of this environments often need to be adapted and equipment put in place to support students and enable staff to meet their toileting and hygiene needs.
Students with cognitive limitations may possess the physical motor skills to carry out the toileting task but may not have the understanding or ability to plan or sequence the activity to complete it independently.
This is something that can be worked on as part of a graded Occupational Therapy intervention programme in the medium and long term to develop independence with toileting and self-care, however, a method of intervention is needed to compensate for any cognitive limitations and enable functional independence in the short term.
Where students have physical limitations or disabilities this may impact upon their ability to execute the correct movement patterns or carry out dexterous components needed for toileting through inadequate gross and fine motor skills. Aspects of toileting such as
hygiene can be very difficult to complete effectively if a student has a limited range of upper limb movement, or limited in-hand manipulation to hold and manoeuvre the toilet paper for example. Areas such as these should ideally be assessed by an Occupational Therapist to identify the limitations within the activity through analysis of the components of the task so that an intervention can be put in place to enable development and independence with toileting. It is also important that as part of any graded intervention for the medium and long term a short term compensatory measure is used to enable independence with toileting until the necessary skills can be developed.
It is important that independence within our daily activities is enabled, especially for the developing young person as this has been found to have a direct link to several areas including self-confidence, self-esteem, self-identity, and overall health and well-being.
Maslow’s (1943) theory on human motivation involved a five tier hierarchy of needs pyramid whereby humans are required to fulfill basic motivational needs such as physiological, safety, love, esteem, self-actualization. Maslow’s (1943) theory reported that humans are focused on the basic needs lower down the pyramid such as physiological, and it is only when these needs are satisfied that humans can then focus on needs further up the pyramid such as self-actualization and self-development.
This work has an important link when considering the toileting needs of students and their ability to engage with or carry out the task effectively. If a student has limitations with their ability to complete toileting and hygiene tasks effectively this may cause them to worry and focus on these basic physiological needs. If these needs can be met through enabling access and support to successfully complete toileting and hygiene tasks then when relating to Maslow’s (1943) hierarchy of needs students should be able to focus more on needs higher up the motivational pyramid such as self-esteem and self-actualization which are fundamental to the student’s global development and educational outcomes; this highlights the importance for the toileting needs of students to be effectively met within schools and places of residence.
This document covers the legal requirements, Government guidelines and ‘good practice’ procedures for toilet specification for disabled students from primary to further education in mainstream and special schools.
The Equality Act 2010 requires that service providers must think ahead and take steps to address barriers that impede disabled people. You should not wait until a disabled person experiences difficulties using a service.¹
¹Government Equalities Office Equality Act 2010 Disabilities Quick Start Guide.
By law (under the Equality Act 2010, which replaces the Disability Discrimination Act) service providers are required to make reasonable changes – including to the built environment – where a disabled service user or potential service user 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.
Further, Statutory Instrument No 2 specifies the number of toilets that pupils MUST have, and lays down a minimum of 1 toilet for every 20 pupils over the age of 5, and the number of toilet facilities must be adequate having regard to age, gender, and any special requirements.
The Priority Schools Building Programme Facilities Output Specification requires pupils should feel “that their needs are respected and met…in areas such as toilets…”.
The Bog Standard campaign for better toilet facilities in schools has found that where schools provide quality toilets, pupils respect that commitment.
Detailed specification guidance for disabled toilet facilities is covered under the Department for Education’s Building Bulletins 104 and 103, the Early Years Foundation Stage Framework, and BS8300:2018.
Building Bulletin 104 Area guidelines for SEND and alternative provision
BB104 replaces BB102, and applies to new build and refurbishment/ conversion projects of educational setting. It addresses ambulant special, non-ambulant special, alternative provision (AP), specially resourced provision (SRP) and designated unit (DU) school accommodation.
The total area of toilet and personal care facilities must include the following toilet provision:
- For special schools, SRP and Units where pupils are less independent, and for pupils aged two to four in any setting, approximately one fitting for every 10 (full-time equivalent) pupil places in total (where Hygiene Rooms are provided all but one of these can be counted towards this number).
- For any setting where pupils are independent and aged five years and above, one fitting for every 20 pupils in total.
- For all settings, at least one accessible toilet for disabled pupils per floor.
- Where there is a hydrotherapy pool, one accessible toilet adjacent to the pool.
- For all settings, separate toilets for staff comprising at least one toilet with wash hand basin plus one for every 25 full-time equivalent members of staff (not including catering staff) rounded up, see the Workplace Health, Safety and Welfare Regulations 1992, Approved Code of Practice and Guidance, L24.
- For all settings, at least one accessible toilet for staff or visitors (which may also count towards the number of staff toilets above).
Hygiene Rooms should be provided as follows:
- For non-ambulant special schools or Units, one Hygiene Room for every 12 non-ambulant pupil places with fixed hoist, a changing bed, a wash hand basin, an accessible WC and accessible shower (if the changing bed doesn’t incorporate one) and space for assistants to change a pupil; for ambulant special schools and AP, one Hygiene Room per setting with fixed or mobile hoist, a changing bed, a wash hand basin and an accessible WC (alternatively the WC can be adjacent and separately accessed).
- There should be enough fittings in any setting to ensure they are easily accessible, particularly where pupils need assistance with their personal care or are learning to be more independent. In a suite for severely autistic pupils there may need to be more toilets to ensure there is one immediately adjacent to a classroom. Accessible toilets for pupils may need to be provided within each key stage area (ideally alongside standard toilets). All accessible toilets must meet the travel distances and access requirements of ADM.
Facilities should also be of the right size – fewer well-placed rooms of the right size work better than an over-provision of undersized rooms. Facilities must also suit the age of the pupils:• Primary: a changing bed against the wall with wash hand basin:7m².
- A changing bed against the wall with wash hand basin and accessible WC: 9m².
- For AP, ambulant special schools or if there are other larger Hygiene Rooms: a changing bed against the wall, an accessible WC and accessible shower: 12m².
- A peninsular changing bed (so that staff can support a pupil on each side) and an accessible WC – 15m².
- A peninsular changing bed, an accessible WC and an accessible shower – 20m².
- All Hygiene Rooms should have either a sluice or some other facility for dealing with waste (to suit the school’s arrangements) and storage for pads, spare clothing etc.
Hygiene Rooms facility
Example of fittings and accessories in a Hygiene Room facility.
Space to Change facility
Example of fittings and accessories in a Space to Change facility.
Building Bulletin 103
Building Bulletin 103 replaces the previous Building Bulletins 88 and 89 re area guidelines for mainstream primary and secondary schools. It requires that the total area of toilet and personal care facilities must include:
- Toilets for pupils: approximately one for every 20 pupils in total, but there must be one for every ten full-time equivalent pupils aged two to four, including reception and nursery places.
- Separate toilets for staff: at least one toilet with wash hand basin plus one for every 25 full-time equivalent members of staff (not including catering staff).
- Accessible toilets for disabled pupils, staff or visitors (which may also count towards the number of staff toilets above).
- In schools with pupils in Year 7 and above, facilities should also include a specialist Hygiene Room with fixed or mobile hoist and space for assistants to change a pupil. In a primary school this should contain a changing bed and accessible WC unless this is included in an adjacent accessible toilet (9m²). In a secondary school this should contain an accessible shower, sluice toilet and a changing trolley (12m²).
Some of the spaces listed above may be designed to allow facilities appropriate to:
- Use outside the school day.
- Particular religious requirements, including orientation and ablutions.
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, and specifically lists educational establishments within its scope.
It advises that people with disabilities should be able to find and use suitable toilet accommodation no less easily than people without disabilities.
Where space is limited, the provision of a single accessible unisex peninsular WC for assisted use caters for all needs, and should be sited as close as possible to the entrance and/or waiting area of a building. It should be no less than 2200mm x 2400mm. 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, and specifically itemises educational establishments among key locations, should have a Changing Places facility.
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 ie 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, ie 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.
- It is noted that a wash & dry toilet in place of a conventional WC can give users greater dignity & independence.