THE NHS EQUALITY DELIVERY SYSTEM

Your Clinical Commissioning Group (CCG) is the part of the NHS responsible for planning and buying health care services in your local area.

We have to make a self-assessment on how well we are doing (a copy is available ifyou would like to view it).

It is important that we check with you that the ratings we have given reflect your experience.

We would therefore welcome your responses to the questions below. All the information you provide will be treated confidentially.

  1. Please let us know the first part of your post code:

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  1. Do you consider that local healthcare services meet your health needs?

Always

Most of the time

Sometimes

Not at all

Please let us know the reasons for your answer

  1. Are you able to be involved as much as you wish to be in decisions about your healthcare?

Always

Most of the time

Sometimes

Don’t know

The CCG will seek to move people between different services when necessary. For example, from hospital discharge to a community based service for rehabilitation.

  1. Have you or a relative ever been transferred from one service to another?

Yes

No

Don’t know

  1. If you have answered “yes” in Q4, in your experience how would you describe the way your transfer of care was managed? (If you have had more than one transfer, please describe your typical experience.)

Extremely well

Well

Badly

Extremely badly

Please tell us why you have selected this choice

  1. In relation to the information you are provided about your health care or about the health services available to you?

Not at all / Sometimes / Most of the time / Always / I don't know
Are you given enough information?
Do you understand the information?
Is the information given in the best way for you?
  1. When you have a doctor or hospital appointment, do you ever experience access problems? (please tick ALL the apply)

Communication

No access to foreign language interpreter

No access to British Sign Language (BSL) interpreter

No loop system

Mobility issues

Access to building

Transport problems

Other

Other: Please give details:

  1. Have you experienced mistakes or mistreatment when you (or someone for whom you care) have received treatment or care from the NHS?

Yes

No

  1. If you have answered “yes” in Q8, - please select all the options which describe the mistakes/mistreatment you have experienced:

Incorrect diagnosis

Incorrect prescription

Physical abuse

Inappropriate language

Disrespect

Poor communication/misunderstanding

Other

Please tell us why you have selected this choice:

  1. Do you know about national screening check-ups or programmes?eg breast screening or vaccinations

Yes

No

  1. If you answered yes, how did you find out about screening check-ups/programmes?

Television advertisement

Poster in doctor’s surgery or health clinic

Letter from doctor

Talk with healthcare staff

Health web-site

A friend told me

I just don’t know

Other, please state:

  1. The NHS welcomes feedback from patients and their relatives. Do you know how to, and feel able to tell us about your experiences, good or bad?

Yes / Not sure / No
Can you tell us positive (good) experience about our staff and services?
Do you feel able to make a complaint if you want to?
  1. If you have made a complaint, was it handled respectfully and efficiently?

Yes

Partially

No

Please give details:

  1. If you have any other comments about issues raised by this questionnaire, please tell us:

So that we can assess how well we have gained the views of everyone, we should be most grateful if you would tell us a little about yourself. Please see below:

  1. Is this a personal response, or are you responding on behalf of an organisation?

This is a personal response

This is a response on behalf of an organisation

  1. If you are responding on behalf of an organisation, please give the name of the organisation and any specific group or department. Please also tell us who the organisation represents, what area the organisation covers and how you gathered the view of members.
  1. If this is your personal response, please answer the questions below.
  1. What was your age on your last birthday?

Under 1655 to 64

16 to 2465 to 74

25 to 3475 to 84

35 to 4485 or over

45 to 54Prefer not say

  1. What is your gender?

Male

FemalePrefer not to say

  1. What is you ethnic group?

White

Mixed or multiple ethnic groups

Asian or Asian British

Black, African, Caribbean or Black British

Any other ethnic group

Prefer not to say

  1. Do you consider yourself to be disabled?

Yes

NoPrefer not to say

  1. If you have answered “yes” to Q21, please tell us what your disability is:

Learning disability or difficulty

Long-standing illness

Mental health condition

Physical impairment

Sensory impairment

Prefer not to say

  1. Do you look after, or give any help or support to family members, friends,

neighbours or others because of long-term physical or mental

ill-health/disability or problems relating to old age?

Yes

No

Prefer not to say

  1. Do you have any dependent children aged under 18?

Yes

No

Prefer not to say

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