Healthwatch Northumberland Feedback and signposting log

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This form should be used to capture public feedback received by HWN and replaces the HWE CiviCRM system. Please familiarise yourself with the  questions below and try to capture as much information as possible when engaging with members of the public. Information will be stored securely and reviewed on a regular basis as part of the reporting process.

Please make it clear that their responses will be shared with Healthwatch England but will be anonymised so they will not be identifiable.

If you have any issues or suggestions for improvements  please contact timh@healthwatchnorthumberland.co.uk

 

1. Feedback captured by (your name) *

 

2. Date feedback was collected/received: *

   DD/MM/YYYY 
 
 

3. How was the feedback received?

 

4. Where feedback was gathered (NOT where they live, we will ask for their postcode later on) e.g. at drop-in at Prudhoe

 

5. Feedback summary/headline. In a few words summarise the details of the case

 

6. Detailed feedback *

 

7. What is the MAIN service type the feedback relates to?

 
*NB Community health services (as defined by NHSE website) include:
  • 2 hour rapid crisis response services
  • District nursing
  • Child health services
  • Community occupational therapy
  • Community paediatric clinics
  • Community end of life and palliative care
  • Community physiotherapy
  • Musculoskeletal therapy
  • Pulmonary or cardiac rehabilitation
  • Community podiatry
  • Community speech and language therapy
  • Falls prevention services
  • Intermediate care services
  • Specialist nurses (for example, diabetes, COPD, heart failure, incontinence, tissue viability)
  • Bed-based community rehabilitation
  • Wheelchair services
  • Health visiting
  • School health services
  • Sexual health services

8. Name(s) of practice or organisation the feedback relates to (up to five organisations)

 

9. Name of any organisation(s) or service(s) you signposted or referred them to (up to five organisations.)

 

10. What happened next/what was the outcome? (eg 'Experience/view recorded') Details can be updated by staff at a later date

 

11. What is the sentiment of the feedback received? (Requests for information or signposting should be categorised as 'Neutral')

 

12. Is this a safeguarding issue? (eg Allegations of abuse/neglect - see NCC Safeguarding for further info)

 

13. What is their relationship to the patient involved in the feedback?

 

14. Full postcode or, at a minimum, their postal town