Alder Hey Children's NHS Foundation Trust

Equality Scheme Feedback Form

Please add your comments here:

Is the Scheme easy to read and understandable?

Yes No

If no, please say what would improve it:

Are the aims of the Scheme clear and understandable?

Yes No

If no, please say why not:

Is the scheme clear about what the Trust is going to do to promote equality?

Yes No

If no, please say why not:

Have we included everything in the Scheme that you think should be in?

Yes No

If no, please tell us what is missing:

Do you have any other comments about the Equality Scheme?

Do you have any questions about the Scheme?

About you (this information is optional)

I am:

If other please specify:

I represent a:

If other organisation, please specify:

What gender are you?

What is your age range?

years

Do you consider yourself to have a disability?

Yes No

If you are a disabled person, please state the type of condition
or impairment that applies to you. If none of the categories
apply, please mark ‘other’ and specify the type of condition.

My disability is :
If mental health, please specify :
If learning disability, please specify :
If other, please specify :

Long term illness or health condition:

If other, please specify:

What is your ethnic origin?

If other, please specify:

What is your religion or belief?

If other, please specify:

What is your sexual orientation?

Which of the following health services do you use or have you used within the hospital?

If other, please specify:

Please tell us what barriers (if any) you have experienced
when using our health services or within the workplace:

Access to written word or images
Access to appropriate information
Communication barriers, e.g. through speech or sound/other
Staff attitudes / behaviours / prejudice towards you
Access to appropriate toilet facilities
Access to a quiet room (or 'prayer room')
Access to your appropriate faith representative
Access to a health care worker of your chosen gender
Physical access
Equipment
Privacy

Please give some examples of barriers you have faced:

What do you think the Trust is doing well in terms of services to meet individual needs? (for example, in terms of race, disability, gender, religion/belief, sexual orientation or age)?

What do you think the Trust can do to improve these services?

Please list 3-5 things you would most like to see changed or improved (please prioritise these):

Your Name (optional):

Address (optional):

Telephone (optional):

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