Section 1: About You

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Scope of Survey

We are collecting feedback from carers about their experiences of ReSPECT forms and Advance Care Plans as part of End of Life Planning for their loved one. We are looking for feedback from people who:

Live in a Staffordshire County Council Area
Care for someone aged 65 or over

How we use this information

The information you share with us will mainly be accessed by Healthwatch Staffordshire and analysed for our research reports. This helps us to spot trends both locally to identify areas for improvement. In order to highlight areas for improvement, your feedback may be shared with Healthwatch England, Staffordshire County Council, the local Integrated Care Board or local NHS Trusts. We may use quotes in our reports but we will not use any information that will identify you.

As well as your feedback, we may also ask you to volunteer some personal information like age group. Find out more about how we handle your information in our Privacy Statement.

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Some groups are working with us, to increase the reach of our survey. If you are completing the survey as part of a group, then please select the group from the list below, so that the group will get credit for your response too.

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Please indicate if you are the service user or carer

Service user (You must be over 65)

Carer (The person you care for must be over 65)

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If you are the carer please tick what is your relationship is to the service user?

Spouse/Partner

Son/Daughter

Sibling

Grandchild

Friend

Neighbour

Other (please specify)

This is required

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How long have you provided care or support for this person?

Less than 6 months

6 months–1 year

1–3 years

More than 3 years

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Approximately how old was the person you cared for?

65–79 years

80 + years

90 + years