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Hospitals White Paper

Provision of Assisted Accessible Toilets (including Changing Places) in theHealthcare Industry

Building Regulations Approved Document M 2013

Department of Health
Health Building Note 00-02
Sanitary Spaces 2013/Welsh Health Building Note(WHBN) 00-02 Sanitary Spaces

BS8300: 2018 Design of an accessible and inclusivebuilt environment

Equality Act 2010

One in 6 of the British population is registered disabled.

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

  • 1.5million wheelchair users
  • 6.5million people who have either bladder or bowel incontinence
  • 1.5million people with a learning disability
  • 1.2million people living with stroke
  • 62,000 amputees
  • 30,000 people with cerebral palsy
  • 500,000 people with acquired brain injuries
  • 100,000 people with multiple sclerosis
  • 70,000 people with muscular dystrophies
  • 5,000 people with motor neurone disease
  • 8,000 people with spina bifida
  • 40,000 people with spinal injuries
  • 120,000 people with a stoma
  • 3.8million adults morbidly obese
  • 0.8million disabled children
  • 8.7million people with osteoarthritis
  • 400,000 people with rheumatoid arthritis

All of these people visit hospitals, and many need the help of a carer,All of these people visit hospitals, and many need the help of a carer,particularly to go to the toilet.

Some 30% of NHS users in the UK are disabled, and hospitals are theSome 30% of NHS users in the UK are disabled, and hospitals are the second most inaccessible buildings for them. (Papworth Trust disability in theUK report).

The toilet access report – Making a Case for Fully Accessible Toilets Within The toilet access report – Making a Case for Fully Accessible Toilets Within the NHS – says toilets in NHS buildings have been found that are unsafe, and that fail to ensure the dignity, safety and well being of patients, staff and carers.

A person empties their bladder and/or bowel every 2-3 hours. The wait in A&E can be hours…

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

In the worst case – yet most likely – scenario, the user could end up having to lie on the floor to be changed. Their carer faces risk of injury having to manoeuvre them without the support/help of a hoist. And what if their carer needs the WC? What do 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.

This document covers the legal requirements and ‘good practice’ procedures for assisted accessible toilet specification for disabled visitors.

Building Regulations Approved Document M 2013

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, BS8300:2018).

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 at least a hoist and adult-sized changing bench.

To enable users and their carer(s) to manoeuvre, a Space to Change shouldbe a minimum 7.5m2 (in total, including the 2.2m x 2m of the ‘Document M’ type wheelchair-accessible WC).

Department of Health: Health Building Note
00-02 Sanitary Spaces 2016/ 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 wc facilities. Its latest edition now includes Changing Places and advises:

Changing Places toilets should provide:

  • Wheelchair access to the changing table, toilet and hand-rinse basin;
  • Transfer from a wheelchair to the toilet or changing table;
  • Use of the toilet;
  • Use of a hoist;
  • Changing older children/adults with continence problems;
  • Disposal of soiled nappies/continence pads;
  • Hand rinsing;
  • Personal washing.

Further, 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.

BS8300:2018 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 disabled people should be able to find and use suitable toilet accommodation no less easily that 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 WC for assisted use caters for all needs, and should be sited as close aspossible 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 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, shower and shower seat, and track or mobilehoist system
  • Enough space, 3m x 4m, to enable manoeuvring for the disabled personand up to two carers, for a centrally located (peninsular) toilet with roomeither 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.

Changing Places Typical Layout

Equality Act 2010

The Equality Act 2010 replaces the Disability Discrimination Act. Under it,service providers are required to make reasonable changes – including to thebuilt 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 andThe Equality Act 2010 requires that service providers must think ahead andtake steps to address barriers that impede disabled people. You should notwait until a disabled person experiences difficulties using a service.1
1Government Equalities Office Equality Act 2010 Disabilities Quick Start Guide

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

The Closomat solution

Closomat is the UK’s largest and longest-established specialist supplier ofdisabled toileting equipment. It is unique in offering, in-house, full designadvice, supply, installation, commissioning and maintenance.

Closomat is Britain’s leading supplier of disabled toileting solutions.

It is the only company in its sector which manufactures wash & dry(automatic shower) toilets – the brand-leading Closomat Palma Vita, Lima Vita and Lima Lifter – in the UK.

The company also supplies the full ambit of accessible toileting, washroom,hygiene and changing room equipment, including shower equipment, hoists, height adjustable fixtures and fittings.

Closomat is unique in also having, in-house, expert project management services.

Closomat is already the leader in the provision of disabled toilets, hygienerooms and Changing Places toilets to healthcare industry, having completed successful projects at, among others, MASH (Multi-Agency Specialist Hub)Suites in Kent, Finchley Memorial Hospital, Leighton Hospital and Darlington Memorial Hospital.

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