Carers Questionnaire

Family and Carer Feedback

People who provide unpaid care and support to those using our mental health, learning disability and autism services are often known as carers. Carers can be family members, friends and neighbours.

We are really keen to hear about your experience whilst the person that you care for has been accessing care and treatment. We would therefore be grateful if you could complete this questionnaire.

	If other please specify

Q4	What type of mental health care and support did the person that you care for access?

	If you cant find the service or ward from the drop down list please use the space below to tell us who you saw.

Q4b	Which adult mental health service did the person that you care for access? (including wards)

Q4c	Which children and young peoples mental health service did you / your child access? (including wards)

Q4d	Which rehab and high support unit is the person that you care for currently staying on?

Q4e	Which older people's mental health service did the person that you care for access?(including wards)

Q4f	Which learning disability service did the person that you care for access?

Q4g	Which drug and alcohol service did the person that you care for access?

	If you cant find the service or ward you accessed from the drop down list, please use the space below to tell us who you saw.

Did you feel that staff recognised you and the role you played in providing care and support to the person that you care for?

Always

Sometimes

Rarely

Never

	Any additional comments

	If other please specify

Did you feel that staff welcomed your views, knowledge and any concerns you had about the person that you care for?

Always

Sometimes

Rarely

Never

	Any additional comments

Did you feel that staff were happy to listen to you?

Always

Sometimes

Rarely

Never

Did you feel that staff involved you in decisions about the care and treatment planning for the person that you care for?

Always

Sometimes

Rarely

Never

	If rarely or never can you tell us why you think that is?

Q10

If medication or treatment for the person that you care for was introduced or changed, was this explained to you ?

Always

Sometimes

Rarely

Never

	Additional comments

Q11

Did staff explain confidentiality (what information could and couldn't be shared) to you?

Always

Sometimes

Rarely

Never

Q12

Did the person that you care for ever stop you receiving information from staff about their care and treatment?

Yes

Not sure

Q12a

Were you offered support and general information if the person that you care for wished not to disclose information to you?

Yes

Not applicable

Q13

Were you aware of any particular staff who had a role in supporting you as a carer?

Yes

Q14

Were you provided with any of the following information ? (please select all that apply)

Staff roles / who is in the care team

General information

Visiting times

Information about ward rounds and the opportunity to attend

Information about what the service / ward provides

No information provided

Telephone numbers / key contacts

Q15

How was the above information provided to you? (please select all that apply)?

Verbally

Information leaflet / pack

Website

No information provided

Other

	If other, please tell us

Q16

Was the format of this information appropriate for you?

Yes

	Please tell us what format you would have preferred this information in (e.g. language, pictorial, BSL,etc.)

Q17

Were you provided with information on what to do if you have concerns about the person that you care for?

Yes

Q18

Did staff make you aware of dedicated services that are available to support you as a carer?

Yes

Q19

Did staff make you aware of your possible rights to a carers assessment?

Yes

Q20

Overall, how satisfied were you with the support you as a carer received from Pennine Care?

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very Dissatisfied

Q21	Was there anything else that you would like to tell us?

Q22	Are you ?

	If you would prefer to self identify please use the space below

Q23	What age are you?

Q24	What is your ethnic group?

	If other please specify

Q25

Do you consider yourself to have a physical or mental health condition or disability?

Yes

	Please provide more detail about your disability:

Thank you for taking the time to share your experience.

Making the patient and carer voice loud and unmissable in Pennine Care