• Adult (18+) community-based specialist palliative care - how are we going to deliver the new model of care

    An opportunity to give your views on how we best improve care

  • This is an anonymous and confidential questionnaire. Only the NHS will be gathering the responses.

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  • About the potential service delivery options

    This questionnaire is part of our engagement on potential service delivery options for the new model of care for community-based specialist pallitaive care:

    • That sets out the the approach we used to develop the widest possible list of scenarios and establish a ‘long list’ of potential options for delivery of the proposed new model of care
    • Describe how we examined these options to arrive at a shortlist.

    You can view the potential service delivery options by clicking here.

  • About you

    Your answers to these questions will enable us to analyse the response from this survey and understand more clearly where there may be differences of views between different groups of stakeholders. 

  • 1a. Are you a current service user/patient of adult community-based specialist palliative care services in North West London?
  • 1b. Are you a carer or family member of a service user of adult community-based specialist palliative care services in North West London?
  • 1c. Are you a member of NHS staff?
  • 1d. Are you completing this on behalf of an organisation?
  • 0/50
  • 0/50
  • 2. Which borough do you live in?
  • 0/200
  • 0/200
  • 0/200
  • 0/200

  • Please tell us a little more about yourself

    We are keen to hear from a broad mix of people and to consider any differences or potential service adjustments that may apply to different groups. Completing the next section will help us to assess which groups we have engaged.

    This section is optional, and your views will still be taken into account if you choose not to complete this section.

  • 7. Which age are you?
  • 8. Which of the following options best describe how you think about yourself?
  • 9. Is your gender identity the same as the gender you were given at birth?
  • 10. Do you have a disability?
  • 11. Please select which describes your ethnicity?
  • 12. Please indicate which option best describes your religion or belief?
  • 13. Please indicate the option that best describes sexual orientation?

  • Keeping in touch with you

  • 14. It would help us to know how you heard about this engagement?

  • Please note we will not link your email address to the answers you have given to the consultation questions.

    You can read our privacy policy by visiting our website.

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