Healthwatch Northumberland Feedback and signposting log

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

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Feedback captured by (your name)

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Date feedback was collected/received:

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How was the feedback received?

if 'Other' selected, please specify:

This is required

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

If 'Other' selected, please specify:

This is required

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

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Detailed feedback

What is the MAIN service type the feedback relates to?

If 'Other' selected, please specify::

This is required

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

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2.

3.

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5.

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

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5.

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

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

Positive

Neutral (eg requests for information)

Negative

Mixed (both positive and negative)

Unclear

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

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Feedback captured by (your name)

Date feedback was collected/received:

How was the feedback received?

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

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

Detailed feedback

What is the MAIN service type the feedback relates to?

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

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

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

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

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

Is this a patient safety issue? (Has there been unintended or unexpected harm to people during the provision of health or social care?)