Join the Northumberland Adult Social Care People's Panel

Healthwatch Northumberland is working with Northumberland County Council to deliver the Adult Social Care Peoples Panel. The aim of the Panel is for you to have your say and help shape adult social care services in Northumberland

If you receive care, care for a family member or friend and want to make a difference in adult social please complete the application form below to get started.

Derry Nugent, Project Coordinator at Healthwatch Northumberland will review your application form and keep in touch with you throughout the joining process to becoming a new member. You can call Derry on 03332 408468

Your contact details will be securely stored on the mailing list managed by Healthwatch Northumberland. Only if you consent will we share your email or relevant contact information with Northumberland County Council for the purpose of managing Panel meetings. No other information will be passed on or shared with any other parties. The mailing list will be used to keep panel members up to date on the work of the Panel and share opportunities to get involved.

1. Your contact details *

First Name	*
Surname	*
Address	*
Post code	*
Date of birth	*
Phone number	*
Email	*

2. Please tell us a little about yourself and your background *

3. Why would you like to join the Peoples Panel? *

4. What would you like to get out of being a part of the Panel? *

5. Are there any specific skills and experience you want to contribute? *

6. Do you have any ongoing health concerns that we may need know about or accessibility needs to help you take part? *

7. Which category best describes you? Please tick one or more boxes *

I currently receive Adult Social Care Services
I used to receive Adult Social Care Services
I am a carer
I used to care for a family member or friend
I am a retired or former Health or Social Care professional

Data sharing
As a Citizen Peoples Panel, our members share information in with Healthwatch Northumberland and Northumberland Council. Our members consent to being part of a ‘members only’ panel open email group which helps communication and collaboration on specific project work within the confines of the group. Please note we do not ‘Bcc’ (blind carbon copy) members email addresses within the group unless specifically requested.

Please confirm you have read and understood the above statement and tick the below box if you to provide consent to joining our Citizen the Adult Social Care Peoples Panel open mailing list and sharing relevant information as is defined.

8. I am happy to participate as described

Yes