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Tell us what you think

We would like to hear from you, your family or carer about the service and care you have received. We welcome your comments, good or bad, and would be grateful if you spend a few moments to complete this questionnaire.

This information will be used to improve and develop our services in future.

Please answer as many questions as you can and tick the box which you think is most appropriate. Please use the comments box to explain further.

When completed, please put this leaflet into one of our comment boxes (found near reception or in the wards). You can also pass it to a member of staff.

Personal response about an urgent issue

If you would like a personal response about an urgent issue, please speak to the staff involved or ask for the manager or matron. They will be pleased to help.

Other help

If you would prefer to speak to someone not directly involved with your care and treatment, you can contact the Patient Advice and Liaison Service (PALS).

This service is confidential and provides help and support to resolve any concerns you may have. It can provide advice and information about the NHS and social care and all feedback is welcome.

You can contact PALS on 01271 314090 between 9.30am and 4.30pm or by email: pal@ndevon.swest.nhs.uk

You can also visit the PALS and Information centre in person at North Devon District Hospital in Barnstaple. Or alternatively it may be possible for us to arrange an appointment in your area.

Also see Getting involved and having your say

Service and location

Where did you receive treatment? (eg, name of hospital/ health centre, at home)

Did you use a particular service? If so, what was it? (eg, audiology, district nurse, eye clinic)

Did you stay in hospital? If so, which ward?

How good was the service given by:

Doctors:
 very good OK poor don't see/don't know no comment

Nurses:
 very good OK poor don't see/don't know no comment

Therapists:
 very good OK poor don't see/don't know no comment

Housekeeping staff:
 very good OK poor don't see/don't know no comment

Admin or reception staff:
 very good OK poor don't see/don't know no comment

Care and treatment:

Thinking about the main person or team looking after you…

Did they include you in planning your care?
 yes, all the time some of the time no don't know no comment

Were you given information you could understand about any treatments or tests?
 yes, all the time some of the time no don't know no comment

Were you given information you could understand about what was happening to you?
 yes, all the time some of the time no don't know no comment

Was this information easy to understand?
 yes, all the time some of the time no don't know no comment

Were they polite?
 yes, all the time some of the time no don't know no comment

Were they helpful?
 yes, all the time some of the time no don't know no comment

Did you feel cared about as a person?
 yes, all the time some of the time no don't know no comment

Did you feel listened to?
 yes, all the time some of the time no don't know no comment

Did they respect your privacy?
 yes, all the time some of the time no don't know no comment

Did they treat you with respect?
 yes, all the time some of the time no don't know no comment

If you raised concerns, were they dealt with properly?
 yes, all the time some of the time no don't have any concerns no comment

Waiting times:

How long did you have to wait to be seen?
 a few minutes or not at all there was some delay I waited much too long don't know no comment

Please complete the following questions if you were treated in an NHS building

Was the ward or department you needed easy to find?
 yes OK no don't know no comment

Was there a nice atmosphere inside the building? (for example in the waiting area)
 yes OK no don't know no comment

Were the toilets clean?
 yes OK no don't know no comment

Was the room where you were treated comfortable?
 yes OK no don't know no comment

Was it clean?
 yes OK no don't know no comment

Please complete the following questions if you stayed in hospital

Did the meal times suit you?
 yes, all the time some of the time no don't know no comment

Did the meals taste good?
 yes, all the time some of the time don't know no comment

If you have a special diet, was this catered for?
 yes, all the time some of the time don't know no comment

Was there enough variety of meals?
 yes, all the time some of the time don't know no comment

Was the food at the right temperature?
 yes, all the time some of the time don't know no comment

Was the drinks at the right temperature?
 yes, all the time some of the time don't know no comment

Were the visiting times OK for your friends/family/carers?
 yes, all the time some of the time don't know no comment

Were you disturbed by noise?
 yes, by staff yes, by other patients yes, by visitors no can't remember no comment

Overall

In general, how would you rate the service you received?
 very good OK poor no comment

Would you be happy to use the service again?
 yes no maybe don't know no comment

Any other comments

Please use this section to give more details on any of your answers. Was there anything we did well? What could we do to improve our service?

If you would like to receive a personal response to your comments, please provide your contact details below.

Name:

Address:

Phone:

Your Email

Would you like to be contacted in future to help with other patient surveys, consultations or patient involvement events?
 yes no

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