LINk Annual Questionnaire 2011

Your completed form will be entered into a free health and wellbeing prize draw which includes:-:

• First prize: Wii Console
• Second prize: Steamer
• Third prize: Blender

You will need to complete the LINk Registration form with your contact details to be entered into the prize draw and a Equity & Diversity Form for monitoring purpose. Should you have a query contact the LINk in Salford on 0161 743 0088 or info@linkinsalford.co.uk

The purpose of the questions is to understand the views and concerns of residents of Salford about local health and wellbeing services. The LINk in Salford wishes to gain the information to help set work themes for the LINk 2011 – 2012 to improve services in partnership with statutory providers of health and wellbeing services in Salford. Your information will be anonymous for the purpose of the data collection. Please feel free to honestly answer the questions.

Your Information
*Title:
*First Name:
*Last Name:
*Address:
*Postcode:
*Telephone/Mobile:
*E-mail:

Do you think the current cuts in public services will affect current care?
Yes:
No:
Are there any proposed cuts/closures that would have an impact on your health and wellbeing?
Yes:
No:
If Yes to above question, please state:
Do you know who to go to in a care crisis for yourself or other family members, carers, friends?
Yes:
No:
If Yes who:
Would you want your care provided in the community as opposed to hospital care?
Yes:
No:
If Yes why:
GP Services
Do you know what GP commissioning is?
Yes:
No:
Please state your GP/GP practice?
Please state one good thing about your GP/GP practice?
Would you like to see any improvements at your local GP/GP practice?
Yes:
No:
If Yes, please state:
Have you recently been referred for other services by your GP and if so were you satisfied with the arrangements?
Yes:
No:
If No, please state:
Health
Do you know who to go to in a health crisis?
Yes:
No:
If Yes, who:
How well organised do you feel your care was when you last visited the hospital?
Poor:
Average:
Good:
When you last used health services in Salford were you provided information in a competent and professional manner?
Yes:
No:
Please state which health service you accessed:
If you needed an operation would you prefer it to carried out at your local hospital, where they may only perform a few of these operations each year, or at a centre of excellence, where they perform lots of these operations even if it is quite a long way away from where you live?
Local hospital:
Centre of excellence:
Please state why you would prefer this:
Please rank in order of preference of what you would consider a priority of services for LINk work themes. The top priority marked as ‘1’ and the lowest priority marked as ‘16’.
Access to financial information Ambulance care Dementia care Housing Hospital discharge and aftercare into the community Improve quality of GP services in Salford Quality of care homes in Salford Quality of home care / domiciliary care services in Salford Governments agenda for people having personal budgets to buy care services following an assessment Services for people who have alcohol problems in Salford Services for people with a drug problem in Salford Services for people with mental health problems in Salford Sexual health services in Salford Stop smoking services Support and information for carers in Salford Transport (public transport to services in Salford)
Please complete the following statements about health and wellbeing in Salford
The MOST important thing to me is:
The second most important thing to me is:
The third most important thing to me is:
Are there any projects or ideas that you would like to see developed by the Council or health service?
If you were in charge of health, social care and wellbeing services in Salford, how would you spend £1000?
Any other comments, suggestions and ideas that you have not raised in this questionnaire.