One in 6 of the British population is registered disabled. People with illness and disabilities visiting hospitals should be afforded the opportunity to have appropriate toileting and Changing Places. In 2018, the Department of Health made £2million available for acute hospitals to improve the provision of Changing Places in NHS Hospitals. It is hoped that installing them in acute hospitals which have the greatest footfall, this will have the largest, positive effect on those needing to use the facilities. This funding is open to applications until March 2021¹.


From January 2021, new hospitals are required to install a Changing Places Facility by law. As the government is aiming to build 40 new hospitals by 2030, the number of accessible facilities will increase steadily over this time. The effect of the Coronavirus pandemic on this funding is yet to be determined.

Potential users of an accessible toilet with space, changing bench and hoist may include:

  • 1.2 million wheelchair users.²
  • 6.5 million people who have bowel control problems.³
  • 1.5 million people with a learning disability.4
  • 1.2 million people living with stroke.5
  • The rising number of people with a limb amputation in the UK.6
  • The 1 in 4 children diagnosed with cerebral palsy every year.7
  • The 1.4 million people who are living with an acquired brain injury in the UK.8
  • The 130,000 people who are living with multiple sclerosis.9
  • The 70,000 people with muscular dystrophies.10
  • 5,000 people with motor neurone disease.11
  • 50,000 people with spinal cord injuries, with approximately 1,200 new cases per year.12
  • The 1 in 500 people who have a stoma.13
  • The 10 million people who have arthritis, or other similar joint conditions.14

All of these people may need to visit hospital, and many need the help of a carer, particularly to access a toilet.

If someone with disabilities or bladder or bowel issues needs the toilet, and/or needs carer assistance, there are issues of manual handling, hygiene and safety if only standard ‘disabled’ (Document M) toilets are available.

If appropriate facilities are not provided, the user could end up having to lie on the floor to have continence wear changed.

Their carer faces risk of injury having to manoeuvre them without the support/help of a hoist. It should also be considered that their carer may also need to use a toilet. What would they do with the disabled person who they are responsible for?

An appropriate alternative, now deemed ‘desirable’ under Building Regulations, is the inclusion of a Changing Places toilet. Provided IN ADDITION TO conventional wheelchair-accessible toilets, this has more space, and more equipment, notably an adult-sized changing bench and hoist.


Building Regulations Approved Document M 2015

This document covers the legal requirements and ‘good practice’ procedures for assisted accessible toilet specification for disabled visitors. Toilet accommodation needs to be suitable, not only for disabled people, but for all people who use the building.

For disabled people, suitable toilet accommodation may take the form of a specially designed cubicle in separate-sex toilet washrooms, or a self-contained unisex toilet.

Some disabled people 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).

However, many facilities do not have the space to accommodate a Changing Places in addition to the conventional wheelchair-accessible toilet.

A Space to Change facility fills that gap. It takes advantage of the additional space often already incorporated into the conventional wheelchair-accessible toilet to further include a wheelchair accessible toilet, a hoist and an adult-sized changing bench.

To enable users and their carer(s) to manoeuvre, a Space to Change should be a minimum 7.5m² (in total, including the 3m x 2.5m of the ‘Document M’ type wheelchair-accessible toilet).


Health Building Note 00-02

Department of Health: Health Building Note 00-02 Sanitary Spaces 2016 (England) Welsh Health Building Note 00-02 (Scotland refers to DoH Note).

The Health Building Note gives ‘best practice’ guidelines for healthcare buildings. It recommends assisted toilet facilities. Its latest edition now includes Changing Places and advises:

Changing Places toilets should provide:

  • Wheelchair access to the changing table, toilet and hand wash basin.
  • Transfer from a wheelchair to the toilet or changing table.
  • Use of the toilet.
  • Use of a full room cover overhead track hoist system.
  • Changing older children/adults with continence problems.
  • Disposal of soiled nappies/continence pads.
  • Hand washing.
  • Personal washing.15

Furthermore, where provided, they should be in public areas for ease of access to everyone who needs to use them, with comprehensive guidance on the design and equipment.


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 non-disabled people’. The time taken to reach a toilet is an essential element to be taken into account in its siting.

Where space is limited, the provision of a single accessible unisex peninsular toilet 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 Standard further recommends that any larger building where the public have access in numbers of where visitors might be expected to spend longer periods of time, and specifically itemises health facilities, such as hospitals, health centres and community practices among key locations, should have a Changing Places facility.

A Changing Places toilet aims to meet the needs of people who require a carer to assist, and provides as a minimum:

  • The correct equipment i.e. a height-adjustable adult-sized changing bench, height-adjustable wash basin, shower and shower seat, and a full room cover ceiling track hoist system.
  • Enough space, 3m x 4m, 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 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.

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.


Space to Change facility

Example of fittings and accessories in a Space to Change facility.


Equality act 2010

The Equality Act 2010 replaces the Disability Discrimination Act. Under it, 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 disabled people. You should not wait until a disabled person experiences difficulties using a service.*

*Government Equalities Office Equality Act 2010 Disabilities Quick Start Guide.

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


References

¹Department of Health (2019) Changing Places capital funding for NHS hospitals, retrieved from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/805195/changing-places-capital-funding-for-nhs-hospitals-prospectus.pdf (accessed on 10/02/2021).

²NHS 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).

³NHS England 2015, retrieved from: https://www.england.nhs.uk/blog/martin-mcshane-11/ (accessed on 31/01/2021).

4Mencap (2021), retrieved from: mencap.org.uk/learning-disability-explained/research-and-statistics/how-common-learning-disability (accessed on 21/01/2021).

5Stroke Association (2021), retrieved from: https://www.stroke.org.uk/ (accessed on 31/01/2021).

6Public Health England (2019), retrieved from: https://www.gov.uk/government/news/preventing-amputations-major-concern-as-diabetes-numbers-rise (accessed on 31/01/2021).

7Scope (2021), retrieved from: https://www.scope.org.uk/advice-and-support/cerebral-palsy-introduction/ (accessed on 31/01/2021).

8Barber et al (2019), retrieved from: https://commonslibrary.parliament.uk/research-briefings/cdp-2018-0145/ (accessed on 31/01/2021).

9MS Society (2021), retrieved from: https://www.mssociety.org.uk/what-we-do/our-work/our-evidence/ms-in-the-uk (accessed on 21/01/2021).

10NHS (2018), retrieved from: https://www.nhs.uk/conditions/muscular-dystrophy/#:~:text=Who’s%20affected%20by%20muscular%20dystrophy,UK%20at%20any%20one%20time

11Motor Neurone Disease Association (2020), retrieved from: https://www.mndassociation.org/about-mnd/what-is-mnd/basic-facts-about-mnd/ (accessed on 31/01/2021).

12NHS England (2019), retrieved from: https://www.england.nhs.uk/publication/spinal-cord-injury-services-all-ages/ (accessed on 31/01/2021).

13Colostomy 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).

14NHS (2018), retrieved from: https://www.nhs.uk/conditions/arthritis/ (accessed 31/01/2021).

15Department of Health (2016) Core elements Health Building Note 00-02: Sanitary spaces, retrieved from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/525745/DH_HBN_0002.pdf (accessed on 10/02/2021).

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