Relative/Friend Questionnaire. | Healthwatch North Lincolnshire

Ward 27 relative and friends survey

Are you the patients relative or friend?

Please state in the box below.

Tell us about the standard of care your relative/friend receives

Please state in the box below.

If you wanted to raise a concern who would you tell?

How do you find the staff?

Is your relative/friend treated with dignity and respect?

Does your relative/friend have access to everything they need? i.e social stimulation, food, drink, support with washing and dressing.

How do you keep in touch with your friend/relative?

Does the ward keep you updated with any changes in your relative/friends condition?

Is there anything else you would like to tell us about Ward 27?

Basic Demographics

Healthwatch collects demographic data which is used to generate insights and understand health inequalities, including challenges some groups face in accessing health and social care services.

As part of your experience, we would like you to provide some basic demographic data below to help us in our mission to improve local services.

What is your age range?(Required)

What is your ethnicity?(Required)

What is your gender?(Required)

Are you or do you consider yourself to be disabled?(Required)

Yes

Do you or do you consider yourself to have a long-term condition?(Required)

Yes

Thank you for completing the above demographic questions.

We do also record more detailed demographic information which will help us further, however this is completely optional.

Would you like to provide any further demographic information?(Required)

Yes

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Please can you tell us your nationality?

Is your gender identity the same as recorded at birth?

What is your sexual orientation?

What is your religion or belief?

What is your marital and civil partnership status?

If you are currently pregnant or have recently given birth, please select if any of the following apply:

Currently pregnant

Currently breastfeeding

Given birth in the last 26 weeks

Would you consider yourself to be from a seldom-heard group or community?

The term ‘seldom-heard groups’ refers to under-represented people who use or might potentially use health or social services and who are less likely to be heard by these service professionals and decision-makers.

Yes

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If they select that they have a disability

You told us previously that you are or consider yourself to be disabled.

Please could you be able to tell us what type of disability you have?

You can select more than one

Physical or mobility impairment

Sensory impairment

Learning disability or difficulties

Mental health condition

Long term condition

Other

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If they select that they have a long-term condition

You told us previously that you are or consider yourself to be disabled.

Please could you be able to tell us what type of long-term condition you have?

You can select more than one

Contacting You

Do you want to be contacted by Healthwatch about your experience?(Required)

Yes

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Contact Details

Please tell us your name(Required)

Telephone Number

Email Address

If you want to be contacted by letter, please provide your address below

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