Slings, hoists and money pits

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Another disability money making scheme?

Recently I had the annual inspection of my ceiling hoist. My hoist covers the area from my bed to my toilet and wheelchair. The inspection includes a visual check that my sling is safe to use. In fact, the law requires a sling inspection twice each year. It costs around £100 for a hoist and sling safety assessment.

My sling is as rugged as hell – in fact I can’t imagine how it would get torn or ripped without slashing it with a knife several times!! Basically it would probably last me 20 years.

However … and here is the rip-off, the sling can fail and be declared instantly unusable if the serial number can not be read.

Now, slings are made to be washed – and just like clothes, the little cloth tag can begin to show faded writing. So my £500-600 sling could be assigned to the bin after a years worth of washes! A perfectly maintained and safe sling, thrown away because of a faded number.

Will companies make a serial number that is permanent that can withstand several washes? Apparently, the word on the street is that key companies were asked to do just that but refused because it brings them greater profits by forcing everyone to repurchase new ones. Imagine schools and hospitals having to pay out thousands each year to get new slings that are otherwise safe to use.

Equally, a company can say they no longer ‘support’ a particular hoist model and the user also has to throw that out within six months as they are automatically deemed unsafe.

The overall result is that individuals, schools and hospitals, public swimming pools, social services and companies who have Changing Places hoist equipment are throwing away large amounts of equipment that may still be usable for a number of years.

Products that are purchased are now being chosen because they are cheap to replace and not because they are safe, dignified, comfy and the ‘right one’ for the user.

Calling all manufacturers…

I invite manufacturers of patient slings and hoists to comment on their policies and manufacturing processes where efforts are being made to ensure serial / product numbers can last the lifetime of any sling and that ‘discontinued’ products can still be supported for the life of existing equipment . These would also come under the companies policy to cut down on environmental waste.

Rare Breeds Farm trip – where toilets were even rarer.

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Last week I went to the Rare Breeds Centre near Ashford in Kent. It was a day out with my husband, my sister in law and nephew to enjoy all that Highland Farm had to offer.

I never thought that I'd have any trouble finding a toilet because the farm is run and owned by the Canterbury Oast Trust (COT). They support adults with learning difficulties (some of whom use a wheelchair) who are working and volunteering around the site.

[Source: Rare Breed Centre website, 2017]

I imagined it to be super accessible in the toilet facilities although I did know from their website that they had no hoist or bench.

First toilet attempt

The first thing we do when we go out is check the toilet facilities to see if we can manage. My husband would be lifting/dragging me from my chair to the toilet. I am female – with a male assistant which becomes very relevant when we find out there is no unisex toilet in the outside toilet block. There is only an accessible cubicle in the men's and women's toilets. I generally can't use cubicles as they are not big enough for my extra small power chair plus assistant.

This causes a temporary panic. What if we had to go home or drive several miles into Ashford to find a toilet? This was supposed to be a lovely once a year opportunity for a day out with our little little nephew.

Attempt number 2

We went inside the restaurant and I saw there was a sign to toilets and baby changing. Hurrah. I ask a member of staff where I could use the toilet and she escorted me through the doors I could see marked for more toilets. There was a ladies toilet with a large cubicle – so my husband would still have to loiter outside the cubicles.

How would you react if you were a women going to the loo and a man was hanging around inside?

This is embarrassing for my husband and can you imagine a parent's horror when their child reports a man was in the toilet. This is a farm for children and staff / volunteers with learning difficulties – which could lead my husband open to abuse allegations or scare the living daylights out of people.

Also, the toilet (below) had a none standard support rail meaning it offered no support when sitting on the toilet – ( it's located too far forward) so not usable at all for me. The hand dryer is not reachable in the corner and there is no emergency cord.

All in all at this point there were no usable toilets.

Attempt three

I had attended conferences and training events in the adjoining training centre, so I knew I had used the toilet inside. I asked if I could use these and staff went off to see what they could do. Thankfully they opened up the centre so I could use the toilet ….. we'll sort of. This was not a good experience.

I had forgotten that the accessible toilet room was built inside the Men's toilet facing the urinals.

Luckily as there were no events on, the toilets were only used by staff so limiting the chance of them being used whilst we were in there.

The problem here was that the accessible toilet room (inside a room!) was smaller than a standard unisex toilet. In fact, as I parked next to the toilet with my back wheels against the wall – the door wouldn't close!!

We had to take of foot plates etc and tuck my feet in to be able to close the door. My chair is a custom design for a small adult so a regular adult chair user would possible not fit.

There is meant to be clear space under the finger wash basin and a mirror you can see from a sitting position but as you can see these were not provided.

Being a men's toilet there was no bin for sanitary waste and incidentally no bin for continence pads in any toilet we saw.

The toilet has no emergency cord which might be a problem for some people.

If I was a women who could independently use the toilet then I would not be at all comfortable going into a men's toilet block.

If I had a female carer then we are back in that awkward lurking situation.

I will be doing a formal complaint to see if they can come up with a solution to some of these issues.

Helpful or not – petitions

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There are over 80 petitions on Change.org calling for signatures to back calls to governments and businesses for accessible toilets. Most are by individuals calling particularly for Changing Places toilets.

Are petitions helpful?

Psychologically petitions and demonstrations by disabled people and carers are useful – providing the 'I feel I am doing something rather than nothing'. People who sign genuinely want to say 'this needs to change'. However, the reality is that petitions rarely achieve results.

No amount of signatures is going to change the law or monitor adherence to building regulations. In the UK, the government have heard, via parliamentary debates, how we need accessible toilets. They end with empty promises.

As we speak the draft of revised access standards has been drawn up – setting British standards for what could be used in buildings which last over 50 years. They don't include any change to toilet provision. They are based on the dimensions of wheelchairs, for example, from 20 years ago. Petitions won't impact these.

Dilution of support

Petitions aim for x number of signatures …. people might sign one or two but 80? If campaigns were centralised into one petition there could be thousands of supporters rather than a few hundred.

Change in strategy

The movement to ensure toilets for all is disjointed. Often it's based on promoting the needs of children rather than the needs of disabled people of all ages. People with obesity, dementia and autism are often totally ignored. Many campaigns are based on the need for hoists and changing benches – yet we still have toilets being built that are supposed to follow strict building regulations, but don't for 'independent' disabled people. There are failings at every level. Equality laws do nothing to persuade businesses that disabled people need accessible toilets.

What can we do to actually make a difference?

  • Share a petition rather than recreate one for yourself
  • Look out for opportunities to comment on building regulation guidance, local access consultations, health consultations etc.
  • At every opportunity provide feedback about toilet access. Use social media, review websites, council feedback forms, patient feedback cards at hospitals etc.
  • Use formal complaints procedures.
  • Write to your MP
  • Provide witness statements for parliamentary debates

Sounds like a lot of effort? That's why it's easier to sign a petition and have our social guilt relieved – we've done all we can, right? Now everything will be ok?

No it won't – but deep down you know that.

Draft of BS 8300 -2 available for comment

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British standards are helping businesses thrive. Some of them define access for disabled people outside and inside public buildings.

What is a British Standard?

Standards define best practice in many different areas. They’re put together by groups of experts and come in a number of different kinds, from a set of definitions to a series of strict rules. 

… Standards are not the same thing as government regulations, but they’re often used in legislation to provide the technical detail.

(BSI, 2017)

Standard BS 8300 defines access requirements from ‘set down points’ in car parks to the distance to the toilet or width of lifts. There is a section about toilet access, dimensions, fixtures, fittings etc which is best practice. 
A new draft for BS 8300 is available to read and comment on. There are two parts – the toilet section is on 8300-2.

Link to draft BS 8300-1 and BS 8300-2 (enter 8300 in the search). 

Poo at the zoo.

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This week is Love your Zoo Week run by BIAZA. The British and Irish Association of Zoos and Aquariums (BIAZA) is the professional body representing the best zoos and aquariums in the UK and Ireland.

Baby elephant

Chester Zoo

 
1.3 million people visit member organisations every year. Only a small percentage are disabled people and their friends/families because few venues provide toilet facilities with 

  1. a hoist and changing bench, 
  2. space for modern wheelchairs or 
  3. one that is fully equipped for able wheelchair users and those with other impairments e.g. Bowel/bladder disorders, autism, mental ill health, epilepsy, obesity, shortened height.

 BIAZA members contribute over £650 million to the national economy.

If the venue doesn’t provide a hoist or height adjustable toilet, this means a lot of people can’t visit. People with poor balance, weak legs or arms may not be able to stand up from an accessible seat. 

People with muscle and nerve disorders, balance or co ordination difficulties or frailty from old age may need this equipment.  They may not necessarily use a wheelchair.  

There are no height adjustable toilets in any zoo, aquariums or wildlife parks in the UK.

If standing up from the loo (or standing by the loo) is impossible, such individuals have to be lifted up / carried in the arms of relatives or find a toilet with a hoist and changing bench. Wheelchair users with weak arms/legs also need hoist facilities.

Hoist, toilet and changing bench

Chester Zoo


There are a number of zoos etc who provide such essential equipment and the space to use it. 

These are:

  • Marwell Zoo (first in UK to equip toilets for all visitors)
  • Bristol Zoo Gardens
  • Blair Drummond Safari Park
  • Tilgate Park
  • Chester Zoo
  • Chessington World of Adventures Resort
  • Tropical Wings Zoo (opening soon)
  • Folly Farm Adventure Park and Zoo
  • Cotswold Wildlife Park
  • Colchester Zoo
  • Yorkshire Wildlife Park (hoist and toilet)
  • Wingham Wildlife Park
  • Pili Palas Nature World
  • Camperdown Wildlife Centre (opening soon)
  • Edinburgh Zoo (hires in a bed and hoist for 1 week per year)
  • Whipsnade

(List excludes bird and wildlife reserves and parks/forests).

Possible future venues:

  • Living Coasts
  • Paignton Zoo
  • Newquay Zoo
  • Twycross Zoo
  • London (only hoist and bench currently – no toilet)

Specifically stating no hoist facilities:

  • Woburn Safari Park

However, there are over 100 venues who do not offer usable toilet facilities – not even for people who don’t use a hoist.

Why do they exclude disabled people?

Museums and accessible toilets

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Are museums no go zones?

Museum of London, Docklands

Have you ever been to a museum that hasn’t had a toilet for visitors, staff and volunteers? If it’s a medium to large museum – probably not. They are probably high on the list if not essential.

Disabled people are potential employees, volunteers and visitors, yet still so many museums fail to provide usable, safe toilets for people with access needs. 

I’ve been to hundreds of UK museums of all sizes, only 2 fully met my needs. If I am with my care assistants I can only visit places with hoists.

If a museum provides accessible and usable toilets for people, the benefits are perhaps obvious:

  1. Larger pool of employees to choose from
  2. Disabled and older people can visit
  3. More attractive to disabled and older volunteers
  4. More attractive to schools who have disabled teachers or students

This leads to increased community outreach, education, visitors and profits / grants.

Without usable toilets, museums and galleries are choosing not to welcome and exclude disabled people. 

We have accessible toilets

You have to be very ‘able’ to safely use ‘standard’ accessible toilets. You have to have either strong arms or legs (to transfer from a chair or stand/sit), good balance, good dexterity and grip to hold support rails. Many people are not that ‘able’ e.g. people with MD, MS, MND, arthritis, CP, paralysis, stroke, short limbs, learning difficulties, autism, anxiety … that’s collectively millions of people!!

Florence Nightingale Museum


This type of toilet might meet most of the standard criteria but only for the very able. 

Museums need to:

  • Audit standard toilets against the most recent recommendations for access 

This one below has a raised seat which is not part of access criteria and can make it extra difficult or impossible for wheelchair transfers. The toilet roll is high up and the emergency cord is wrapped around the support rail.

Horniman Museum

  • Install either a space to change toilet or Changing Places. These have essential space and equipment like a hoist and changing bench. 
  • Install a ceiling hoist over standard toilets to increase the number of visitors/staff who can only get out of their wheelchair with a hoist (like Lincoln Castle has below).

  • Advertise your facilities or people won’t go if they are not confident there is a usable toilet.
  • Show pictures of your toilets in access guides and provide clear signage.
  • Have regular reviews of toilet access.

It is still disappointing that so many museums exclude people. Most of the big museums across London for example do not provide usable toilets (notably Cardiff and Edinburgh have full facilities in key museums) .  When these London venues are approached they don’t want to know. 

“In Kent there are no museums with hoists in their toilets – so I can’t visit at all.”

Attitudes must change if disabled people are to get inside museums – it doesn’t matter how many tactile maps, quiet areas and ramps you have if people then have to worry if they will wet themselves and have a miserable stressful day out.

Caught short – the myth 

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An interesting comment came my way stating that ‘normal’ people caught short should be allowed to use the accessible loo the same as non disabled people who need the loo urgently.

Let’s put this to bed right here. 

We have covered before how part of the criteria of being accessible is ‘availability’ of accessible toilets. I.e not taken up by non disabled people who could go elsewhere.

So what if the non disabled person is caught short? Well the reason is different. One person has, as an adult, improperly and in error been unable to time when they needed to empty their bladder or bowel. With some mental competence, being caught short could have been avoided. They then wouldn’t have had to dive into an accessible toilet?

 Disabled people might have a medical need known as urgency where they may only have a minutes warning before their bladder releases whether they are in the loo or not. Clearly these people with a medical need (or arguably a medical need from an upset stomach or similar) require available facilities of an accessible toilet to preserve health and dignity. 

Simply being caught short because someone has not made time for the toilet in their day is no excuse to use up an accessible toilet. 

What do you think?

All about support / grab rails

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Taken from our guide (see links page) we look at the importance of support rails in accessible toilets. AD M is approved document M of the U.K. Building Regulations.

It is possible to have many layouts to allow for the provided dimensions and fixture configurations in AD M.
 

The general layout of a unisex accessible toilet is to have horizontal grab rails to both the left and right side of the toilet [AD M: S 5.8].

Heights, lengths and distance from the toilet / sink / mirror etc must be precise as described in AD M.
Vertical rails must also be provided in specific places.

How many rails do people need?

74% of disabled/older people use handrails. They can be used to pull/push up with or simply to lean on for stability.

41% of powered wheelchair users prefer the right side, 30% the left and the rest had no preference in a 2005 study.

Some people need a rail both sides and on the back wall.  The rails needs to be the right height, length, distance from the toilet/sink, thickness and colour.

An accessible toilet must  have at least 5 support rails with additional ones if the toilet is located some distance from the wall. 


Barriers introduced

As can be seen above, support rails can infringe on the transfer space and cause problems for some wheelchair users.

Solutions

  1. Assess your toilet – do they have the full complement of support rails and are they in the right place and the right length / height? 
  2. Mix it up – the standard suggests that if you provide more than one unisex toilet, a choice of layouts for left and right hand transfer should be provided. 
  3. The smaller the space, the more grab rails will get in the way for powered wheelchair users and carers – re-consider your design space. 
  4. Provide Changing Places toilets in addition to existing accessible toilets. The larger spaces to the left and right of a central toilet offer more transfer option angles for people who use powered wheelchairs, large walkers/ frames, or need carers to assist them.

Changing Places low usage?

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Gill, a fellow toileteer, had a couple of questions – which I felt might be a useful topic to take a look at. Here is the first one:

Changing Places: Changing places room is greatly needed and appreciated by users, but it would appear that in general they get very little use. I believe that this is partly due to signage. The facility might appear on an app but once in the building there may be poor directions. Also once found they might well be locked and someone has to go on a key hunt. Apparently some providers are closing them as they have never been used, and the average usage is once every six months. There’s been a suggestion that they could become a more multi use facility? eg first aid room; baby changing room for a disabled parent. Do you have any thoughts on this?

Changing Places and similar toilets are very valuable. However, imagine you’re a shop or tourist attraction who has invested thousands in providing a large fully accessible toilet with a hoist and bench… only to find it’s rarely used. A waste of money, you say angrily, as you knock it down to make way for valuable retail space. 

Aghhhhh. What went wrong?

We can break down some of the key reasons as to why they are at risk of being underused.

1) The toilet is not signposted within the venue or town.

I’m a CP toilet user and so many times I find there is no signposting. I know from the CP map that the venue has one … but it’s not on any venue map, booklet, and no directions given from public toilet blocks. (O2 Arena, Bluewater Shopping Centre and my local town come personally to mind). 

  • If you don’t tell people where it is then they won’t use it!

Yesterday I looked at the CP map and saw Toddingto Services had one … I went in only to find it was on the northbound side and I was southbound. Whilst it’s on the Google map section of the CP map, the description didn’t indicate which side!

2) The toilet isn’t called a Changing Places. 

Staff might not know that a Changing Places toilet might be labelled, in their venue, as a ‘high dependency unit’ , ‘Space to Change’, ‘Hoist assisted toilet’, ‘Adult Changing Room’ etc. as there is no official standard name.  People who use these toilets might not realise to look/ask for alternative names. (Bluewater/O2 Arena / mobile units come to mind).

In Lincoln castle they have a hoist … but they just call it ‘the accessible toilet’.  No mention of it on their visitor literature!

  • Staff training can help.

3) Location, location, location

These toilets might be a significant investment … so location is critical. Even if a large venue has a CP toilet, if you have to walk for 30 minutes to reach it, you might not use it. Maidstone has one in its council building – great only it’s over 30 minutes fast walk uphill from the museum, theatre, main shopping area etc. It’s quicker for me to drive home!! 

  • Toilets need to be central to the action.

Yesterday I was at Chester Zoo. It’s a huge venue. I was a long way away from the CP toilet (about 600 metres) and it was back in the direction we had come from, so I used a basic loo. Does that count as none use or just my personal choice and need for the loo quicker than we could reach it?  The location is good though and well signposted – in fact I’d say in this instance 2-3 toilets would all be used well. 

  • Sometimes too few CP toilets or wrong locations can risk low overall use.

4) How is use being monitored?

Unless a person has to request one to be opened or someone is constantly watching the entrance (and this is being recorded) then usage monitoring might not be happening.  Use might be ‘guessed’ by  something as simple as ‘the bed paper roll’ still looks full or ‘the toilet roll hadn’t gone down in months’.

These methods have obvious flaws.  Thinking of the many CP toilets I have used, only 1 was visible by staff at a reception desk (who had other work to do rather than to vigilantly act as official toilet monitor). How can venues say with certainty if they are being used or not? 

Do cleaners make notes if it looks ‘used’? 

Most are ‘just toilets’ with no special key  and might be used for clothing changes or something which wouldn’t leave any dent in the toilet roll. I often use my own specialist wipes that are flushable – so you’ll never know I’ve been in.

Could they have other uses?

Thinking about secondary uses, the two obvious choices are noted by Gill. A first aid room or for wheelchair accessible baby changing.

The latter could be problematic in that parents using chairs are likely to need to sit under the changing table area to access their baby and CP benches are not open underneath. A height adjustable baby changing table might be an option that could fit in the full size CP toilet to assist disabled parents.

What about using it as a first aid room? There is nothing in health and safety legislation to suggest that a toilet space can not be a first aid room. However, whether someone would want to be treated in a room with a toilet nearby could be a problematic.  Hygiene and infection control may be an issue and CP benches are often just a shower trolley – not meant for laying on for a prolonged period and not that comfy.  There is also the consideration of what you would do if the room is being used and you needed the toilet or someone needed first aid. How likely this is to occur will depend on many factors. Location of the toilet and size may influence any decision to have a multi use room. For small to medium stores etc, multi use may be worth considering with the addition of a chair and first aid cabinet/wall mounted kit. 

Let a toilet be a toilet 

I see a simple solution. You don’t HAVE to use a bench or hoist to use the facility. Why not just have it as a toilet for use by anyone who would normally need an accessible toilet? Do disabled people in general know they can use it? 

Currently building regulations say that venues need a standard wheelchair accessible toilet  … and CP toilets are additional. 

Well perhaps this should change  – the only difference would be a finger wash basin near the toilet (and this could be fitted in a CP toilet as a moveable / swing out basin perhaps). That way one toilet suitable for all could be provided. Even going as far as enabling parents with children in prams to use the room in smaller venues where low use might be a financial issue? 

Maybe, in small venues, we need to start providing shared facilities that serve more than just disabled hoist/bench users. 

Time for a Change?

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The campaign for toilets with an adult bench, hoist and space for 2 carers resulted in the Changing Places Consortium being formed 10 years ago.

Whilst significant campaigning (largely by individuals with varying styles and mostly by parents) has resulted in the provision of over 850 of these toilets, we wondered whether it’s time for a change? 

Campaign success?

There is no single campaign or campaign  strategy for changing places – individuals can do whatever they want. This makes the campaigns disjointed and dilutes or replicates efforts. You see this regularly across the multitude of social media accounts/Facebook Pages and private blogs identifying themselves as campaigners using the CP symbol. Whilst Aveso and the Consortium generate information sheets and ‘Selfie Kits’ etc … there is a blurring of who or what is the ‘official’ approach. 

Protecting young people

Take the recent episode of parents who collected and posted pictures on the Internet of children (and other people’s children and young adults) on the toilet floor, face showing and wearing incontinence pads. Young people unable to consent to this undignified use of their image. If a school or care business did this it would be a serious child protection and human rights issue. However, when I raised this as a concern the Consortium said parent campaigners are not affiliated with them and can do as they wish. This didn’t stop their official social media accounts from sharing the images.  Mixed messages ensued across multiple Internet forums. The rights of the child were lost amidst the the cause, angering many disabled people.

Would not the responsible approach be to support campaigners with training in methods and ideas which protect the privacy and dignity of children? Just because dignity was lost in being on the floor doesn’t mean the indignity should be extended by their image being shared.  Is this the sort of campaign that can only achieve success by using increasingly shocking images? Thankfully many people did indeed use their creativity and there has been a reduction in the use of children as dignity martyrs – and so individual efforts continue and the campaign actively promotes them. 

Pen v. sword?

Individuals can approach companies in any way they want ranging from polite letters and personal conversations to social media harassment. 

It is likely that as much harm as good has been done with these tactics which has divided campaigners for toilet equality.  How can you have a meaningful, positive conversation when the previous contact they had with a campaigner was focusesd on personal anger, emotion and frustration. 

It’s easy to get angry when you have struggled that day in a cramped toilet and are gathering up your evidence to make a complaint or have ‘that’ conversation. You want to throw the book at them, yell at them. You want to drag them into the toilet and make them see what you have to go through. You want them to empathise and make things right – but all you get is a ‘sorry you were unconvenienced’ letter to fuel the next stage of complaint. 

It’s hard not to let personal emotions damage your chances of negotiating an agreement to provide a toilet you and thousands of others can use. However, we have to remain polite, persistent, factual and professional. Unfortunately not all campaigners do – and that’s a big problem.

Time to rename and rebrand?

Many have kept their distance or tried to move things on locally. There have been issues with Changing Places being built that fall short of the recommended guidelines of 12 sq metres. That said it is a guideline. Some felt a smaller room was acceptable and out sprang the Space to Change campaign with its own logo. Then things became problematic with determining which ones were listed on the CP toilet map.

Recently a local campaign for a new branding of ‘Hoist Assisted Toilets’ has gathered momentum. In fact, one of the problems with the CP toilet was that they were very focused on the needs of people who used incontinence pads. This alienated (in name and focus) people who were continent but needed a hoist or those who needed a bit more space or other equipment. People didn’t like asking for a Changing Place due to the remaining stigma of incontinence. 


This has led to CP toilets being called other names including ‘high dependency unit’, ‘Space to Change’, ‘Adult Changing Room’ etc. It’s confusing and has resulted in staff and visitors talking cross purposes and toilets not being found.  If there was a single campaign with good leadership, one name, one symbol and one strategy then we might have more of these toilets.

The future of toilets 

The result of the above could indicate that change is needed in many areas if we are to benefit from more Changing Places toilets in the UK.