Schools are making giant strides in terms of pupil health. Canteens boast their healthiest ever food offerings, and a wide range of sport is encouraging more pupils to exercise. But one largely ignored issue is threatening to unravel all that good work: school toilets.

The smallest room in the school can have one of the biggest impacts on pupil health, education and happiness. Pupils consistently report dirty, smelly, vandalised or locked school loos, or a prohibitive lack of privacy. Many toilets are too crowded to use during short breaks, yet teachers are reluctant to let pupils go during lessons.

Kathleen, 16, from the Vale of Glamorgan, Wales, says her school toilets are not as bad as some, but could still benefit from some basic improvements. The girls currently have to go to the loo in pairs: one to use the toilet and the other to hold the door shut with their foot because the locks are broken. Bars of soap are crushed into the plughole, the sanitary bins are overflowing and wet balls of toilet paper cling to the ceiling, she adds.

“What annoys me most is when the whole school is punished because a minority of pupils deface the toilets,” says Kathleen. “The school locks the toilets, so we have to walk from one end of the school to the other to go to the toilet.” Inevitably, pupils then get into trouble for being late for class.

Government guidance is contradictory, however. On the one hand, inspectors must assess how schools contribute to the five Every Child Matters outcomes, including the need for pupils to be healthy, safe and to enjoy and achieve; yet the inspection of school toilets is still not part of Ofsted’s remit, or outlined in the Healthy Schools initiative.

“School toilets were the first place I would visit,” says a former Ofsted inspector. “If a school can’t get the toilets right, it can make you wonder how much they care about their pupils and what else is deficient.”

As summer approaches, teachers will be encouraging pupils to drink more water, squash or juice during the school day. But many will refuse - too scared, unwilling or unable to face unhygienic toilets or the unsavoury characters that might dwell there.

The resulting dehydration can cause constipation, headaches, tiredness and poor concentration. About half of pupils surveyed by the UK Youth Parliament in 2004 said they regularly avoided going to the toilet at school, preferring to “hang on” until they got home. Up to 40 per cent feared being bullied in the toilets.

Another survey, conducted in 2005 by bathroom manufacturer Armitage Shanks, found that seven out of 10 schools had toilet blocks installed more than 20 years ago and that more than half of schools rated their toilets as poor.

Although there’s a requirement for there to be one toilet for every 20 pupils in schools, their condition and location remain unregulated. The result can be Dickensian conditions, says Nickie Brander from Bog Standard, a campaign group for the improvement of school toilets run by the charity Eric (Education and Resources for Improving Childhood Continence). She receives hundreds of complaints from pupils every year who say their toilets are inadequate.

“I’ve been shown some horrendous things,” she says. “I saw one secondary that didn’t have any doors attached to the boys’ toilet cubicles. You can imagine that they didn’t feel too comfortable using those facilities.”

Schools where pupil voice is high on the agenda will already know how much importance they place on the state of toilets. Loos frequently crop up as the top priority in school council meetings, alongside improvements to the playground.

The school council was the first to raise the issue at Kingswood College of Arts in Hull. Although the toilets had already been refurbished five years before, the school decided it needed to look at them again. Last October, the school opened what it believes to be “probably the best toilet facilities in the country”, according to its website, complete with a school logo built into the floor, touch-sensor flushes and all-in-one handwash-and-dry units.

Floor-to-ceiling doors and piped classical music offer pupils total privacy, says Tony Hammond, the director of resources at Kingswood. And although the school is to be rebuilt in September 2012, he insists that pupils should not have to wait that long for decent toilets.

But not everyone supports the investment. The Daily Mail berated the soon- to-close school for spending pound;100,000 on “classical music in loos”. In fact, the money was spent on the whole bathroom, plus new lockers, changing rooms and a dance studio.

“We can’t stop investing in our current pupils just because we’re moving to a new school,” Mr Hammond told the TES Magazine. “Good toilets are a basic human right that our pupils deserve right now.”

Peter Clarke, the late children’s commissioner for Wales, took a similar stance. In his 2004 review, Lifting the Lid on the Nation’s School Toilets, he questioned the level of respect conveyed to children when they are expected to carry out “private and intimate functions in appalling environments”. His survey found more than 60 per cent of pupils were unhappy with the state of their toilets.

“There is really no excuse for the nasty school loos I so regularly hear about,” he said. “It’s just a question of taking responsibility, making it a priority and involving children and young people.”

The recent government specifications, Toilets in Schools, should help schools get it right. The document aims to disseminate best practice for schools that are being refurbished or rebuilt under the Building Schools for the Future (BSF) programme. Published in 2007, it sets out how design, layout and access can ensure toilets are valued and well maintained.

Its main recommendations are that toilets should be available throughout the day, kept clean, and that drinking water should be located elsewhere. It also suggests making handwashing areas more publicly visible, perhaps by making them a continuation of a corridor or by installing transparent glass walls.

The toilet block at Bower Park School in Romford, Essex, was the first to be completed under the new national guidelines this February. Pupils were involved in the choice of fixtures, fittings and dark blue colours from the outset and are now responsible for daily monitoring and managing of the toilets. Brittons School in South Hornchurch, Essex, will be the next to use the blueprint later this year.

One of the key elements of good school toilets is location, the guidance states. “You don’t want them in some godforsaken corner of the school where adults never venture,” says Ms Brander. “Instead, they should be at the heart of the school - that allows for passive supervision.”

At Tong High School in Bradford, which moved into a new building last September, the main toilet pod is located off the large central atrium so that adults can easily see into the main open-plan wash area. The unisex room has a circular trough at its centre (to eradicate deliberate flooding), with bright self-contained cubicles all around (to enhance privacy).

“We spent nearly as long discussing the design of the toilets with the architects as we did discussing the whole of the rest of the school,” says Julie Birkett, business manager and BSF lead at the school.

The previous building had separate girls’ and boys’ facilities, but teachers wanted to reduce the area for communal gathering in the new toilets. “We took off the entrance doors to the toilet areas to allow for better supervision,” Ms Birkett says. The overriding feel is modern, she adds, “like something you’d see in a nightclub”.

It’s not difficult to achieve, insists Christina Thompson from Anshen and Allen, the architects that designed the new school. “Pupils want safety, hygiene and cheerful facilities, with plenty of soap, paper and hot water,” she says. “If we show these kids some respect and provide them with the kind of facilities we would want for ourselves in our homes and offices, that might encourage them to respect the facilities, each other, and the adults in charge of their care.”

There was nothing particularly wrong with the toilets at Collis Primary in Teddington, Middlesex. It was just that they were not very nice. “They were far from ideal,” admits David Butterfield, the school’s headteacher. “The cleaners did their best, but they were dark, cramped, unappealing areas.”

He was determined that the partial new-build two years ago would include toilets that were fit for purpose. Year 5 pupils worked on the design of the cubicle doors in their art and design and technology lessons, finally creating an environmental-cum-jungle scene.

The 24 new toilets all carry the design, although the old toilets in the original Seventies building have not yet been touched because of budget restrictions. The school has started to ring-fence the minimum Pounds 80,000 needed to rip out and replace the old loos, and hopes to phase in the refurbishment this summer.

“It’s expensive, but it’s what the pupils deserve,” says Mr Butterfield. The new toilets come with trough sinks that minimise flooding and splashing, economy taps, liquid soap, electric hand-dryers and movement- triggered lights. In stark contrast, the old loos are uninviting; the poor lighting does nothing to enhance the chipped red plywood and high cisterns. The word the Collis pupils use to describe them is “manky”.

The impact of bad toilets is more than aesthetic. In the Youth Parliament survey, no teachers realised there might be a fear factor about going to the toilet and almost 90 per cent were unaware of the health problems associated with “hanging on”.

It’s little wonder as teachers receive no training on bladder health or conditions. Fiona Lennard, a physiotherapist at Ipswich Hospital who specialises in continence, says it is having a disastrous impact on young people’s general health. Two years ago, about three children a year visited her with incontinence problems. Now she sees five times as many.

She says pupils should aim to drink up to two litres of liquid a day and go to the toilet five to seven times a day. But many of her young patients never go for a pee at school. And the extension of the school day means pupils are hanging on for ever longer stretches, either causing or exacerbating constipation.

“It can have a considerable impact,” says Ms Lennard. “A lot of kids think if they don’t drink, they won’t leak, but that’s not the case. The urine will just become more concentrated and irritate the lining of the bladder.”

An over-stretched bladder increases the risk of leaks or infections, and a back flow of urine can also cause serious kidney and heart problems in later life.

Ms Lennard sees a lot of teachers who have become incontinent as a result of over-stretched bladders brought on by not using the loo when they need to. When they do go, they are likely to find pleasant staff toilets. After all, adults in schools are entitled by law to a clean, private toilet with soap and warm running water. Pupils have no such protection.

If teachers never frequent the pupils’ toilets, they may never realise how horrendous their facilities can be. Bog Standard has established a toilet charter (see box below) to educate teachers and raise toilet standards. But Ms Brander says many teachers fall at the first hurdle, refusing to allow pupils to use the toilet as and when they need to.

“It’s the domino effect,” says one teacher. “If you let one child go during lessons, they all want to go. It can interrupt the lesson and it’s also not unknown for pupils to arrange to meet their mates in the loos, cause damage and wander around the school getting into trouble.”

There is particularly little leeway given to pupils who want to go straight after break or lunch. But that may be the only time when the toilets are quiet, insists Ms Brander. “The toilets may be very busy during breaktime,” she says. “Even if there’s no bullying, it can be intimidating to have to push your way past a group of older girls all doing their make-up round the mirror. You need privacy to open your bowels, and busy toilets or broken locks with no loo paper don’t offer that.”

For toilets to be comfortable spaces, they must also cater for the specific needs of the people who use them. Altmore Infant School in East Ham, London, was built as a secondary school in the Thirties, complete with heavy brick partitions and overhead cisterns. Many of the little boys could not master the urinals and the stench that emanated from the dark, dank bathroom was overwhelming.

“It was really horrible,” says Sarah Soyler, deputy head at Altmore. “Someone had volunteered to draw a Mickey Mouse on the wall to cheer the place up, but the children were scared of his big teeth and there were rumours that the boys’ toilets were haunted. Some children refused to go in there.”

When asked what one thing would make the school better, the pupils were unanimous. The school toilets were totally gutted two years ago at a cost of pound;42,000. The boys opted for a football theme, including a pitch etched into the floor, while the girls wanted pink cubicles with stars painted on the vanity units.

“They conformed to stereotype, but it’s what they said they wanted,” says Ms Soyler. “Because the original cubicles were so high and heavy, we went for curved, sweeping doors which the kids do peep over. If we did it again, we’d make the partition walls higher.”

Apart from that, the refurbishment has been a big success. The pupils are more hygienic because they enjoy using the brightly coloured liquid soap and are also much better behaved in school.

But simply improving the state of the toilets will not improve behaviour overnight, warns Ms Brander. The senior management team must consult with pupils as well as work on behaviour to ensure the new toilets remain attractive and welcoming.

A school toilet policy may seem like a step too far for some schools, but it can help to enshrine these principles and ensure a consistent approach to how and when the toilets are used and maintained, argues Ms Brander.

“It is a powerful indication to children and parents that teachers value and respect the welfare of their pupils,” she says. “I have seen hundreds of cases where the children respond accordingly.”

Setting bog standards

1. Pupils must be allowed to use the toilet whenever they need to.
3. There must be enough toilet cubicles for all pupils.
5. Toilet cubicles must be private and have doors that lock.
7. Pupils with special needs must have suitable, easily accessible toilets.
9. Toilets must be looked after properly and not smell.
11. Warm water and soap must be provided, plus towels or hand dryers.
13. There must be enough toilet paper in all cubicles.
15. Sanitary products and disposal units must be provided in toilets for girls aged eight and over.
17. Toilets must be free from bullies and smokers.
19. Schools must have a policy to keep pupils’ toilets clean and in good condition.
21. Pupils must be involved in managing and improving their toilets.
23. All complaints about toilets must be taken seriously.

24. School Toilet Charter: www.bog-standard.org.