For thousands of stoma users, life in London is lived on a ‘loo leash’ – a daily existence dictated by the availability of toilets.
Stray too far from a known facility, and the consequences can be humiliating. Public transport becomes a gamble, city centres a no-go zone.
Transport for London (TfL) has pledged £3 million a year for five years to improve toilet facilities across the network.
The £15 million investment will add toilets to two Underground stations and five Overground stations, with upgrades at three more.
It’s a rare step forward in tackling one of the capital’s most neglected accessibility issues. But for stoma users – and many others – is it enough?
London’s toilet deserts: where facilities are furthest apart
TfL aims to ensure passengers are within 20 minutes of a free toilet without changing lines – but for many, particularly those with stomas, even that’s too long.
Current data shows passengers on the Overground and DLR face the worst access.
The Suffragette Line (Barking to Gospel Oak) leads with a 35-minute gap, followed by Windrush (Clapham Junction to Whitechapel) and the DLR (Lewisham to Stratford) at 33 minutes.
The Central Line’s longest gap is 24 minutes (Bank to White City), while Northern Line passengers wait 22 minutes (Morden to Waterloo) – both major commuter routes.
By contrast, newer lines fare better: the Elizabeth Line’s shortest gap is just six minutes, with the Victoria, Jubilee, and Metropolitan lines all keeping waits under eight minutes.
‘Nobody wants to be the minister for poo‘
Raymond Martin, managing director of the British Toilet Association, has spent more than two decades campaigning for better access – and watching governments ignore it.
“There’s no legal duty for councils to provide toilets,” he said. “They clean streets, bury the dead, run schools – but toilets? They’re discretionary.
“Toilets don’t have a home. Are they a health issue? Waste? Economy? They fall into all of them, yet none at all. Government needs to say: ‘This is where the buck stops.’ But nobody wants to be the minister for poo.”
Martin says a lack of statutory responsibility – and funding – has left public toilets in crisis.
Feasibility challenges add to the issue, with anti-social behaviour such as drug use, rough sleeping and vandalism leading to toilets being removed from Underground stations two decades ago.
He believes toilets should be free, but acknowledges cost is a barrier.
Martin added: “Running a toilet can cost up to £20,000 a year. A small charge helps fund upkeep and deters abuse.
“A small step that would make a big difference would be a smart map showing every TfL toilet.
“It takes effort to put together, but the will is there, the want is there.”
His story comes from personal experience, which drove him to push for change.
Martin explained: “I was widowed in childbirth and left raising a newborn and a toddler alone.
“Every five minutes it was, ‘Daddy, toilet!’—at the shops, the park, the beach. I even considered buying a motorhome just to have a toilet on board.”
He often bluffed his way into the ladies’ toilets with his daughters, avoiding rancid men’s facilities.
“I remember thinking – someone has to fight for this, because nobody else is,” Martin said.
“I don’t want my daughter growing up in a place with no sanitation, I don’t want to live in a city where people are forced to urinate in the street or defecate behind shop doorways.”
A city left behind by cuts
Caroline Russell, a Green Party London Assembly Member, has long campaigned for better toilet access.
Her involvement began with a study into bus driver distractions, revealing that many endured long shifts with no toilet access.
“Toilets have been victims of years of salami-slicing cuts driven by austerity,” she said. “In every borough, there’s a story about the lack of toilets.
“The impact is huge. I’ve heard of delivery drivers resorting to plastic bottles in their vans, it’s shocking – the lack of dignity that comes from inadequate toilet provision.
“The lack of public toilets is degrading our city, but it’s about more than avoiding urine-soaked alleyways. It’s about enabling people to live healthily.”
TfL data confirms that central London sees the heaviest footfall, with Westminster, Camden, Islington, Tower Hamlets, and Newham handling the most passengers – unsurprising, given their key transport hubs.
But the toilet map paints a different picture. Facilities are clustered in outer boroughs like Ealing, Hillingdon, and Redbridge, while central areas – where demand is highest – are left behind.
A stark divide emerges: north west and north east London fare better, but south of the river, the situation is dire.
No borough has more than three TfL-operated toilets – Croydon being the best of a bad lot.
| Borough | Toilet Scarcity Index |
|---|---|
| Lambeth | 16.2 |
| Southwark | 9.6 |
| Westminster | 8.1 |
| Islington | 7.4 |
| Camden | 5.4 |
| Tower Hamlets | 5.2 |
Lambeth tops the list with a TSI of 16.2 – just one toilet at Elephant and Castle serves the borough, despite its place as London’s eighth-busiest.
Westminster, the city’s busiest borough, also fares poorly. With 10 accessible toilets, demand still far outstrips supply.
The pattern is clear: central London’s high footfall collides with a critical shortage of facilities.
TfL’s £15 million pledge is meant to address these gaps, but campaigners remain unconvinced it will be enough.
“They’re making progress in reducing gaps between toilets on the Tube,” Russell said. “But even 15 minutes is too long – especially for people with stomas.
“We’ve asked the Mayor to double the budget for retrofitting toilets into Tube stations.”
A lifeline for some – but only if it exists
For stoma users, toilet access is a necessity.
A stoma is a surgically created opening that diverts waste into a colostomy bag, bypassing the digestive or urinary system. It’s a lifeline for more than 200,000 people in the UK – roughly one in 335 – but few consider the daily challenges of managing one in a city where public toilets are scarce.
Giovani Cinque from Colostomy UK says stomas are needed for various reasons: Crohn’s disease, colitis, bowel cancer, endometriosis, and other serious conditions.
Some people need one after trauma – car crashes, cycling accidents, even violent injuries.
Cinque explained: “One of the biggest challenges is leakage. It can cause skin irritation, but if a bag starts to leak in public, waste seeps into your clothes. It’s hugely embarrassing.”
Most public toilets aren’t equipped for this. Stoma-friendly facilities need hooks for clothes, shelves for supplies, bins for disposal, and mirrors for bag changes – but many lack even the basics.
A Colostomy UK survey found that 62% of stoma users say lack of toilets affects their daily life, and 53% have experienced a public bag leak.
“City centres like London are turning into no-go areas for some people,” Cinque added. “If you can’t be sure you’ll find a toilet, you’re going to stay home.
“That leads to tough decisions. People start limiting what they do. They don’t go out. They become lonely, socially isolated. If they need to change a bag during work and can’t, they might have to ask: Can I keep working here? Do I need to request reasonable adjustments?”
Public toilets might not be a glamorous cause, but for thousands of Londoners, they mean the difference between freedom and isolation.
TfL’s five-year commitment is a step forward, but without sustained action and leadership – many will remain trapped by the city’s failing infrastructure.
Mark Evers, Chief Customer Officer at TfL, said: “We know that toilet provision is absolutely essential. For many people, including those with bowel and other health conditions, it’s the difference between going out and not, which can have a profound impact on their lives.
“This is why we are investing £3m in toilet provision this year as part of £15m committed over five years – the biggest investment in toilets that London’s transport network has ever seen.
“This funding from the Mayor is enabling us to deliver an ambitious programme to increase and improve toilet provision across our network, introducing new facilities, enhancing and reopening existing ones and improving cleaning.
“Work is underway at several stations and we will soon announce the next set of locations. This all fits into our wider Equity in Motion plan to make London’s transport network more accessible, fair and inclusive.”
The Government were reached out to for comment.
Feature image credit: Photo by raver_mikey on Flickr (CC BY-NC 2.0) and citytransportinfo on Flickr
(CC BY-NC-ND 2.0)
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