England is facing a public health crisis as a severe shortage of public toilets forces people across the country to alter their daily lives and risk their health, according to a stark warning from health leaders.
The Scale of the Shortfall
New analysis by the Royal Society for Public Health (RSPH) reveals the sheer extent of the problem, with the number of facilities across England plummeting by 14 per cent since 2016. The organisation’s calculations, based on Freedom of Information responses from 221 local authorities, show there is now just one public toilet for every 15,481 people in England. This stands in stark contrast to devolved nations, where the ratio is approximately one per 8,500 people in Scotland and one per 6,748 in Wales.
The decline is part of a long-term trend, with traditional council-operated facilities having reduced by an estimated 50-60% since the 1990s. Local authority expenditure on public toilets has halved since 2010, and BBC Reality Check data indicated UK councils stopped maintaining 13% of public toilets between 2010 and 2018.
Consequences for Health and Well-being
The RSPH cautions that this severe shortfall is having a range of detrimental effects, starting with public hygiene. The lack of facilities contributes to an increase in public urination, fostering unhygienic conditions. This trend is borne out by statistics from Scotland, which recorded a 392% rise in public urination offences in February 2022 compared to the previous year.
For individuals, the consequences are profound. Many people, particularly women, are deliberately restricting their fluid intake when out in public to avoid the need to find a toilet. This practice risks dehydration, which can lead to headaches, fatigue, kidney stones, urinary tract infections, and more serious bladder and kidney problems, thereby placing additional strain on the NHS.
The mental and social impact is equally severe. The anxiety and stress of not knowing if a toilet will be available can deter people from leaving their homes at all. William Roberts, chief executive of the RSPH, stated that for some, access to a public toilet “can be the difference as to whether they leave the house,” leading to social isolation and a feeling of being “prisoners in their own homes.”
This anxiety disproportionately affects vulnerable groups. A spokesman for the Local Government Association confirmed the shortage disproportionately impacts older people, people with disabilities, those with medical conditions, parents with young children, and people sleeping rough.
Economic and Social Fallout
The crisis also degrades the public realm and hits local economies. The RSPH suggests the absence of adequate facilities leads some people to stay home rather than venture out, potentially reducing spending in town centres and on high streets. Some individuals are now choosing to shop online rather than visit physical businesses due to the lack of facilities.
Councils attempting to maintain provision face significant financial and logistical hurdles. The LGA spokesman explained that maintaining a single public toilet can cost a council up to £25,000 a year, a figure greatly impacted by vandalism and anti-social behaviour. Incidents of graffiti, damage, and arson cost councils millions annually, necessitating more frequent cleaning and better security, with the taxpayer ultimately footing the bill.
Proposed Solutions and Funding
To reverse the decline, the RSPH is calling for a new statutory approach. It wants new strategic authorities to have a duty to ensure there are sufficient public toilets in the places people go, supported by dedicated funding from central Government. Furthermore, it argues developers must be required by regulation to include public toilets in any new development that includes non-residential units—a move supported by the British Toilet Association, which advocates for provision to become a statutory duty for local councils.
Many councils have already turned to community toilet schemes, partnering with local businesses to allow public use of their facilities. However, the LGA acknowledges that gaps in provision have opened despite these efforts, particularly as businesses close on struggling high streets.
The government points to existing funding mechanisms. A spokesman for the Ministry of Housing, Communities and Local Government said over £78 billion has been made available for council finances, with local leaders free to decide how best to spend the majority of it. For specific needs, the government launched a £30 million fund in summer 2021 to increase the number of “Changing Places” toilets—larger accessible facilities for people with complex disabilities. Round two of this fund aims to allocate up to £6.5 million. Currently, there are approximately 1,800 registered Changing Places Toilets in the UK, with the Scottish Government launching a separate £10 million fund to boost numbers in Scotland.
While around 30-35% of UK toilets have some accessibility features, and there are over 9,000 RADAR key locations providing access to locked facilities, campaigners argue much more needs to be done to create a public realm that is genuinely accessible and welcoming for all.
