Minimum standards for school toilets are needed to improve child health

Inadequate provision, accessibility and maintenance of toilets in primary and secondary schools have been linked to the high number of children suffering from constipation and toilet related health problems.

Following a national survey in 2003 (Community Practitioners’ and Health Visitors’ Association, 2004), the Bog Standard campaign – the campaigning arm of ERIC (Education and Resources for Improving Childhood Continence) – recently commissioned a survey of over 130 schools in the UK and Nursing Times readers to clarify the problems still being faced.

The new survey asked about solutions that could help schools, school nurses and, ultimately, the children and parents who are regularly seeking help from the charity and its campaign.

The reality

The survey found that schools were making the improvement of toilet facilities a higher priority, with 73% having renovated their toilets in the past five years, while 17% of schools surveyed said they had no funds to make improvements. Many commented that parent power to help lobby the government to release more funding for schools building maintenance would be valuable.

The survey clearly shows that schools understand that toilet maintenance must be a priority. Many invest time and money in keeping them up to standard, yet the research found that one in four schools still had complaints from their pupils.

Poor standards, lack of toilet paper and smelly conveniences were top of the complaints listed. Schools stated that 36% of their staff were aware that the schools toilets were smelly, that cubicles had missing locks and supplies of soap were insufficient.

All schools asked agreed that there should be a minimum standard for school toilets, and 58% felt a school toilet award scheme would encourage schools to raise or maintain standards.

The consequences

If toilets are poor, children are reluctant to use them, with many trying to hold on all day until they get home. Repeated toilet avoidance can lead to chronic constipation and cause or exacerbate incontinence and urinary infections.

Children fail to drink adequately at school if they do not want to use the toilets or because they are not allowed to use them when they need to. Of the schools surveyed, 79% said that they felt poor facilities could lead to children developing toilet related health issues, and 84% felt this could have a negative effect on a child’s learning.

All Nursing Times readers surveyed believe that poor school toilets are a contributing factor to incontinence in children. One school nurse said: “School toilet issues continue to cause children and parents concerns in nursery, primary and secondary school settings. Broken toilet seats, no hand soap, no toilet paper, no lighting, broken locks on doors, no sanitary bins, locked toilets and bullying away from adult supervision are all an issue.”

The Bog Standard campaign encourages parents to view the toilets at their child’s school, especially if they feel their child is not happy to use them. From the schools survey, it was revealed that only 17% of schools very occasionally had a parent ask to view the toilets. These figures may change, however, as the Good Schools Guide recently encouraged parents to visit the toilets when choosing a school, stating they are more important in the assessment of their child’s educational life than traditional indicators such as IT or sports facilities (www.goodschoolsguide.co.uk).

Supporting schools and nurses

The Bog Standard campaign is working to raise standards of provision and access to school toilets in the UK, by getting schools to recognise their value.

School nurses have played an important role in the Bog Standard campaign and in ERIC’s separate but related Water is Cool in School campaign. Many nurses are continuing to promote drinking water initiatives and are encouraging schools to both improve the standard of toilet facilities and, equally important, to allow pupils to use the toilets without restriction.

While the results from the research suggest that an increasing number of schools are improving their toilet facilities, there is still much work to be done to achieve acceptable standards in all schools.

This is not helped by the lack of legislation on school toilets or by the National Healthy Schools Programme, which omits school toilets entirely from its programme, resulting in schools achieving healthy school status even if they have unhealthy toilets. Nor is it helped by the exclusion of toilets from Ofsted criteria for inspections. None the less, it is encouraging that toilet standards appear to have improved since ERIC’s last research.

School nurses have a key role to play in encouraging more schools to improve standards of cleanliness, comfort and privacy and in encouraging more schools to allow a humane policy on toilet visits. School nurses can find support materials on the Bog Standard website and the Bog Standard campaign is continuing to push for making high standards of school toilets a government priority.

Author Jenny Perez is director of ERIC, Bristol

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