Health and Social Care Committee

Public health implications of inadequate public toilet facilities

PT 4 – Welsh Senate of Older People

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Health and Social Care Committee

Inquiry into public toilet provision in Wales

Since its launch in October 2010, the Welsh Senate of Older People in Wales has provided a ‘united voice for older people in Wales’ by bringing together 57 older people’s organisations across Wales, including the four national organisations of older people in Wales: National Pensioners Convention Wales; National Old Age Pensioners Association Wales; Pensioners Forum Wales and the Older Peoples Advisory Group Cymru.

The Welsh Senate of Older People calls on all older people’s groups, forums and organisations from across Wales, to join the Senate to achieve the following objectives:

 

 

 

Central Government, the Welsh Government, other agencies and bodies and the general public as considered appropriate.

·         To support the work of and make representations to the Older People’s Commissioner for Wales.

 

 

Public Toilets – Our ‘P is for People’ Campaign

We believe that public toilet provision in Wales is an issue which requires urgent examination and action. Public toilets are an essential part of our communities, and adequate provision is vital to enable us to retain our dignity and the confidence to participate in community life. Poor public toilet provision has a major impact upon many people as it reduces their ability to remain active and restricts how often, and for how long, they are able to leave their homes. This can lead poor health, loneliness and isolation.

The Strategy for Older People in Wales focuses on wellbeing and promoting independence, but without adequate access to public toilets many older people remain unable to take advantage of services as they are not confident of being able to access a public toilet when away from their home.

 

We believe that public toilets are an essential facility within our communities, and that this issue is important for people of all ages. Everyone needs to use toilets whilst they are away from their home: for disabled people, pregnant women, young children, older people and those with health conditions this need can be much more urgent and acute. When toilets are not available, it poses a risk to an individual’s dignity. This can have a significant negative impact on their sense of independence and confidence using community services.

 

In order to challenge this we held a Day of Action at the National Assembly for Wales on 16 November 2011. We were delighted that over 100 people attended to give their support, 38 Assembly Members took the time to come and meet with us with almost half of all Assembly Members signing a Statement of Opinion in support of our campaign.

 

During the Day of Action we asked older people who supported the event to tell us what public toilets mean to them. All quotes included in our response come from the people who attended, and we are very grateful they shared their stories with us.

 

We hope that this inquiry will go some way to identifying ways in which decision makers and the wider community can work together to make sure that there are enough accessible and clean public toilets available in our communities.

 

What are the effects of public toilet provision (or lack thereof) on the health and social wellbeing of a person?

 

The lack of suitable public toilets in Wales causes a wide range of problems for people of all ages. In many cases the fear of having an ‘accident’ limits how often, and for how long, people are willing to leave their home. Some people refuse to go to visit new places for fear of there not being suitable public toilet provision. In most extreme cases this can lead to people becoming housebound.

 

In terms of wellbeing the fear of having an accident can hugely limit how much a person can get out and about and engage in social activities. For some, simply having a well placed toilet at a local park or bus station would mean being able to be independent and enjoy life.

 

A lack of public toilets impacts on physical, mental, social and emotional health and wellbeing costing the NHS more than would adequate toilet provision. People experience a poor quality of life from isolation, lack of social contact and a loss of independence.

 

One of the most notable health risks of poor public toilet provision is the potential it has to make people feel forced to skip essential medication, or limit fluid intake, to minimise the risk of having an ‘accident’.

 

People have told us the following about the implications for them of poor public toilet provision in their communities:

 

“I regularly take water tablets…If I need to go out I don’t take them and this can make me ill. It is a matter of dignity, I don’t want to feel ashamed.”

 

“Having to stay at home = isolation, depression, due to bowel condition from an illness. This has lasted 2 years. Now I can go out if there are toilets en route to and at the destination. No toilets = I can’t go / join in.”

 

“Fear of urine infection if public toilets not available.”

 

“I avoid drinking because often there is no loo available”

 

Is there evidence of people being unable to leave their homes due to concerns over the availability of public toilets? If so, what are the health and wellbeing implications of this?

 

Many people who attended our ‘Day of Action’ at the Assembly had a friend, neighbour or relative who were unable to leave their home as often as they wanted to, or in some cases at all, because of the lack of public toilets.

 

In most cases people stay at home because of the fear of having and embarrassing accident. This fear shapes their lives and leads to isolation, depression and generally a poor quality of life.

 

Given that many people in Wales suffer with incontinence it is important that public toilets are available and clearly signposted so that people can leave their homes with confidence.

 

For some, the limits having no public toilets places on them going out include accessing basic services such as visiting the GP. This can lead to health problems reaching crisis point before anyone becomes aware this is the problem. It costs the NHS a lot more to treat things once they become a significant problem rather than catching them early on, or even preventing their onset in the first place. Poor public toilets do not just limit access to community life, they mean being unable to access anything for some people.

 

We know some people find it costly to visit places where you have to go into establishments and buy food or drink in order to use their facilities. As people’s finances become limited the added cost of having to spend money on using private business’ toilets can force them into having to stop going out at all.

 

Some examples include:

 

“Trapped at home as uncertain where I can go if I need to.”

 

“I regularly take water tablets; this stops me from going places because of poor toilet provision”

 

“I have stress incontinence – have had it for some 30 years – after childbirth – I need to use the toilets urgently when necessary. If I know that there is no toilet I am unable to go to that place.”

 

“Having undergone surgery for advanced bowel cancer I was very aware of public toilets in the area and trips to Bronglais for Chemo made it very tiring trip. Thank goodness for the Aber toilets, without them I would have been housebound as I have little control and when I had to go there was no time to wait.”

 

“I will be unable to go out as I get older if there are not enough toilets in convenient places”

 

“Afraid to go to unknown or strange places.”

 

“I need to take medication regarding water tablets, sometimes I have to rush back home if I am desperate, making my day quite difficult.”

 

“I need the loo at least every two hours. I love the outdoors and visiting places of interest. I find I am forced to limit my trips e.g. Taff Trail by the lack of availability of facilities close to the Trail in local villages”

 

“No toilets means I cannot come to town to shop”

 

“I am a carer. My cared for needs to use a toilet frequently and usually at very short notice. There is only one toilet in our valley which means he is unable to stray far from home. When in Bridgend or other places we need to drink numerous cups of tea or coffee in order to use toilets in cafes etc”

 

“I suffer from IBS and it causes me to have urgent bowel actions. I always have to make sure I know where the nearest toilets are and I can get their quickly otherwise I soil myself which is most embarrassing. Shopping in particular seems to bring it on. We have a shopping centre, now very busy, in Llanishen, which has been built without toilets”

Is there equality across Wales - and in relation to all people - in the provision of public toilets?

 

·        How should public toilet facilities address the needs of different groups of people (men, women, disabled people, people with special health needs, children)?

·        Is there a particular need for improved facilities for specific groups?

 

It is important that public toilets are clean, accessible and clearly signposted. In particular cubicles need to be big enough to enable someone with limited mobility to move with ease and hand rails should be attached.

It is important that toilets are located in the right areas, for example at transport hubs and in shopping centres. It is also essential that they are open at convenient times and all year round.

In particular there is a need for changing rooms or unisex facilities which carers and those being cared for can access together if they are of a different sex. Those who are catheterised or who use colostomy bags may need help and often public toilets do not have enough space, or cater for the disposal of such waste e.g. sanitary bins are usually not available in men’s toilets.

 

What could the wider effects of inadequate public toilet provision be on public health and the community? E.g. correspondence sent to the Petitions Committee suggests that there is a risk of street fouling and a consequential spread of disease.

 

The decreasing number of public toilets is of considerable concern to us in terms of hygiene and public health. Public toilets were introduced to remedy the fouling of pavements and we are worried that as more toilets close this will become an increasing problem.

 

On occasions where people can’t find a toilet they may urinate or defecate in public, revealing themselves to others. This is anti social behaviour. In some areas you can smell that people have relieved themselves in alleyways or shop doorways and we know in some areas councils have had to pay for special cleaning to be undertaken to make sure that the mess is cleaned up.

 

This is not just happening in commercial areas, it is happening in communities and at beauty spots. It is important that people are not forced to find alternatives to toilets as this is a health hazard and unpleasant for all.

 

Comments we have received include:

 

“Last week a very nice car parked by my house.  A gentleman got out, crossed the road to the bank, which is part of my garden and disappeared into the bushes.  When he reappeared, my neighbour asked him what he was up to and very embarrassed he explained that he had been caught in traffic on the M4, got off at Junction 28 and had been bursting for the loo and there wasn't one on the A246 through Bassaleg, Rhiwderin, Lower Machen or Machen and he had seen the convenient leafy lane and grabbed the opportunity.  What could I say?  there are no public toilets between Newport and Caerphilly.”

 

“In our village (we) have no toilet facilities and (youngsters) have been moved on by the police for urinating behind hedges. This has caused hygiene problems amongst many others.”

 

Conclusion

 

We firmly believe that it is important to the health and wellbeing of all people in Wales for there to be a suitable network of public toilets.

 

Even though financial times are tough we are sure that the human cost of not providing clean and accessible toilets is far too high to ignore.