community needs survey - devon · - 6 - community needs survey – easy read – 17.01.11 learning...

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Community Needs Survey – Easy Read – 17.01.11 Learning Disability Development Team-Kath Bird/Sue Bonnell

Community Needs Survey

This survey is to find out what you think about public services and information

Public Services are things like

Schools

Health Services

Police

National parks

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Transport

What is this survey about?

This survey is about how we can improve your quality of life

All councils are going to have a cut in public spending in the next few years

This survey is part of the Tough Choices Campaign

We want to hear more from vulnerable people and communities

This survey will also help people to make choices on what is most important

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Your answers will help with decisions when setting future council budgets

About the survey

We will not give anyone your name or any other details about you – it will be anonymous

If you do not want to answer a question or tell us something – then just leave that question blank

If you want to talk to somebody about the survey

Telephone – you can telephone 0845 155 1015

E-mail – you can e-mail [email protected]

X

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Getting help with this form

You can get this form in another language or format, like Braille

If you need help in filling out the form

Please telephone 0845 155 1015

Or e-mail [email protected]

What to do when you have finished the survey

When you have filled in the survey – please return it in the pre-paid envelope to

Devon County Council, County Hall, Topsham Road, Exeter EX2 4AZ

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This survey must be returned by 25th February

Thank you

Thank you for filling in this form and sending it back to us

The Questionnaire

Please draw a circle around the answer you want to

choose

Are you filling this form out for someone else?

Yes

No

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My Quality of Life

I am happy living in my local area

Yes

No

Not Sure

I feel there are lots of ways for me to get a job

Yes

No

Not Sure

It is easy for me to get training or adult training courses

Yes

No

Not Sure

It is easy for me to get to use sports and leisure facilities

Yes

No

Not Sure

It is easy for me to get to community activities

Yes

No

Not Sure

It is easy for me to get to lots of shops

Yes

No

Not Sure

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My Quality of Life

It is easy for me to get to use parks and countryside

Yes

No

Not Sure

It is easy for me to get to museums and cinemas and other cultural things

Yes

No

Not Sure

It is easy for me to meet my friends and family at least once a week

Yes

No

Not Sure

It is easy for me to go to church or practice my religion

Yes

No

Not Sure

It is easy for me to have a healthy diet

Yes

No

Not Sure

People in the community treat me with respect

Yes

No

Not Sure

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My Quality of Life

It is easy for me to get child care for my children

Yes

No

Not Sure

Access to Public Services Please draw a circle around the answer you want to choose

It is easy for me to use paths and highways

Yes

No

Not Sure

It is easy for me to get around on public transport, like buses and trains

Yes

No

Not Sure

It is easy for me to re-cycle rubbish

Yes

No

Not Sure

It is easy for me to find and understand information I need

Yes

No

Not Sure

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Access to Public Services

I know what public services can do for me

Yes

No

Not Sure

It is easy for me to get health and social care services in Devon

Yes

No

Not Sure

I feel safe outside in my local area after dark

Yes

No

Not Sure

I feel safe outside in my local area during daylight

Yes

No

Not Sure

I know what to do if there is a major emergency, for example flooding of a town

Yes

No

Not Sure

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Getting Involved Please draw a circle around the answer you want to choose

It is easy for me to get involved in things that help change happen in my area

Yes

No

Not Sure

It is easy for me to get involved in things that help change services that I use

Yes

No

Not Sure

It is easy for me to complain about local public services if I want to

Yes

No

Not Sure

I would like to be more involved in things that help change happen in my area

Yes

No

Not Sure

+

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How would you like to be more involved in things that help change happen in your local area or the services you use? Please draw a circle around the answer you want to choose

Take part in on line surveys

Yes

No

Not Sure

Take part in postal surveys

Yes

No

Not Sure

Be a member of an independent advisory group or panel who look at services, for example Devon Link

Yes

No

Not Sure

Be a member of a special interests group, for example a community or disability group

Yes

No

Not Sure

Be a Board member or a Governor

Yes

No

Not Sure

Be able to talk to my councillor

Yes

No

Not Sure

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How would you like to be more involved in things that help change happen in your local area or the services you use?

Go to public meetings in my area

Yes

No

Not Sure

Go to a Council meeting

Yes

No

Not Sure

Be able to give feedback e.g. using a complaints form

Yes

No

Not Sure

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Other things I would like. Which of the things listed below need to be made better in your local area? Tick up to 5 boxes

Access to nature

Activities

for Teenagers

Affordable Housing

Clean Streets

Community Activities

Community Relationships

Cultural

things (like cinemas)

Education

Things for

young children

Health

Services

Jobs

Crime

Pollution

Traffic Jams

Parks and

Open spaces

Public

Transport

Roads and Pavement Repairs Shopping

Sports and Leisure

Cost of Living and

Wages

Write any other things

you think could be

better in the next three

boxes

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We would like to hear what you think.

Please write in the boxes below

Which public services, information or facilities are most important to you and why?

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Which public services, facilities or information do you have problems using or are unhappy about?

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How would you like things to be improved?

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Services This next part of the questionnaire is about local services and where you think money should be saved.

If you think that more money should be spent on the service put a tick in the green box (+) below.

More +

�� Same

=

Less -

If you think that the same amount of money should be spent on the service put a tick in the amber box (=).

More +

Same =

��

Less -

If you think that less money should be spent on the service put a tick in the red box (-).

More +

Same

=

Less -

��

Please put a � in the boxes below:

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Services

Tips and Recycling

More +

Same =

Less -

Bus services

More +

Same =

Less -

Transport Information

More +

Same =

Less -

Library Services

More +

Same =

Less -

Parks, paths and open spaces

More +

Same =

Less -

Childrens’ centres and family support

More +

Same =

Less -

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Services

Nurseries and pre-schools

More +

Same =

Less -

Child protection

More +

Same =

Less -

Supporting children with special education needs

More +

Same =

Less -

Fostering

More +

Same =

Less -

Free School transport

More +

Same =

Less -

Roads and pavement repairs

More +

Same =

Less -

Road safety

More +

Same =

Less -

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Services

Day service for older and vulnerable people

More +

Same =

Less -

Home care for elderly and vulnerable people

More +

Same =

Less -

Residential care for older and vulnerable people

More +

Same =

Less -

Support for carers

More +

Same =

Less -

Adult education

More +

Same =

Less -

Youth Centres and activities for teenagers

More +

Same =

Less -

Others

More +

Same =

Less -

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Services

Health and Social Care Information

Have you heard about these recent health and social care campaigns or slogans? Please draw a circle around your answer

Catch It, Bin It, Kill It

Yes

No

Not Sure

Act F.A.S.T.

Yes

No

Not Sure

Sex, worth talking about

Yes

No

Not Sure

Change4Life

Yes

No

Not Sure

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Have you heard about these recent health and social care campaigns or slogans?

Sunsafe

Yes

No

Not Sure

5-A-Day

Yes

No

Not Sure

Safe, Sensible, Social

Yes

No

Not Sure

Get Moving

Yes

No

Not Sure

Screening Matters

Yes

No

Not Sure

Healthy Start

Yes

No

Not Sure

I Care, But Who Cares?

Yes

No

Not Sure

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Have you heard about these recent health and social care campaigns or slogans?

Living Well with Dementia

Yes

No

Not Sure

Do you talk to or seek advice from the following about health and social care issues?

Please draw a circle around your answer

GP or your doctor

Yes

No

Not Sure

Other Health professionals, for example nurse or health visitor

Yes

No

Not Sure

Friends

Yes

No

Not Sure

Family

Yes

No

Not Sure

Workplace, for example occupational health or HR

Yes

No

Not Sure

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NHS Direct

Yes

No

Not Sure

Websites (NHS, Department of Health)

Yes

No

Not Sure

Care Direct

Yes

No

Not Sure

Hate Crime, Sexual Assault,

Domestic Violence and Abuse

Domestic abuse is: any threatening behaviour, violence, or psychological, physical, financial or emotional abuse between adults who are, or have ever been intimate partners or family members

In Devon we are working to lower levels of Hate Crime, Sexual Assault, Domestic Violence and abuse. We are worried that lots of these crimes are not reported. If you do not want to complete or fill out the following questions, please move down to the next section “About You”

If you do want to complete or fill out the following questions, please circle your answers

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Abuse or Violence If your answer is “Yes” please draw a circle around your answer

Have you been a victim of abuse or violence in Devon?

Yes

No

If your answer is “Yes” – did you report it?

Yes

No If you did not report it – what would help you to report it? Write your ideas in this box

You can report any matters to the Police on 08452 777444 or by calling in person to a Police Station.

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Sexual Assault or Abuse If your answer is “Yes” please draw a circle around your answer

Have you been a victim of sexual assault or abuse in Devon?

Yes

No

If your answer is “Yes” – did you report it?

Yes

No

If you did report it – were you happy with how it was followed up?

Yes

No If you did not report it – what would help you to report it? Write your ideas in this box


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Hate Crime Please draw a circle around your answer

Have you been a victim of Hate Crime in Devon?

Yes

No If your answer is “Yes” – please draw a circle around the type of abuse

Racism – abuse because of your colour or culture

Disability – abuse because you have a learning, physical or sensory disability

Homophobic – abuse because of your sexual choices

Gender – abuse because you are a man or a woman

Ageism – abuse because of your age

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Other – abuse because of any other things you do or believe in

If your answer was “”Yes” – please tell us in the box below what happened and when it happened

Please draw a circle around your answer

If your answer is “Yes” – did you report the incident to anyone?

Yes

No

If you did report it – were you happy with how it was followed up?

Yes

No If you did not report it – what would have helped you to tell somebody about it? Write your ideas in this box

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About You

Please answer the questions below to tell us about

yourself – this will help us to understand different needs

How old are you?

………………

Are you

male

female

Other…………… ………………….. …………………..

Are you disabled?

Yes

No

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Tell us about your disability (you can tick or circle more than one box)

Blind

Deaf (BSL user)

Hard of hearing or

deaf (not BSL user)

Learning Disability

Long Term Illness or

health condition

Mobility problem

Mental Health Condition Speech problem

Other………………… ………………………. ……………………….

How is your health? – circle your answer

Good

Not sure

Bad

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What language do you speak?

English

Other – write your language in this box

Do you have a car?

Yes

No

Do you have any children

(under 18 years old) living with

you?

Yes

No

What is your religion?

Christian

No Religion

Other religion (please tell us – write your answer in this box) …………..……………… …………………………..

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How would you describe your ethnic origin? – circle your answer

Asian/Asian

British

Black/ Black

British

Chinese

White

Mixed heritage

Traveller/

gypsy White British

Other…..write your answer in this box

How would you describe yourself? – circle your answer

Hetrosexual - Attracted to someone of the opposite sex

Lesbian or Gay - Attracted to someone of the same sex

Bi-Sexual – Attracted to both sexes

Other?

Write your answer in this

box

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What type of housing do you live in? – circle your answer

Owned home

Mortgage

Renting from Council

Renting from Housing

Association

Renting from Private Landlord

Other – write what your home

is in the next box …………………..

………………………………… …………………………………

Are you in work? Are you a student? Are you a volunteer?

Please put a √ in one of the boxes

√ Tick Box

I work in a full-time job (30 hours plus per week)

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I work in a part-time job (under 30 hours per week)

I am self-employed – full or part time

I am on a Government training programme (such as a Modern Apprenticeship)

I am in full-time education at school, college or university

I do not have a job and I am available to work

I cannot ever have a job because of my illness or disability

I work for myself

� X

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I am now retired from my job

I work as a volunteer

I am doing something else (can you tell us what that is in this box?)

Are you a carer?

If you have not been able to tick any of the boxes above, are you a carer?

Yes

No

If you are a carer who looks after someone else living at home who has an illness or disability – are you paid for this?

Yes

No

If you are a carer – how many people do you look after Please put the number in the tick box ��

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If you are a carer – how old is each person you care for Please put the answer in the tick box ��

Where do you live, work or study?

Please tell us the name of the village, town or city where you live

My village, town or city

……………………………………………………… ………………………………………………………

If you work or study, please tell us the name of the village, town or city where you study or work – write it in this box

……………………………………………………… ………………………………………………………

What to do next?

Now you have done the survey form please put it in the pre-paid envelope you were given and post it to us by 25th February 2011

community needs survey - devon · - 6 - community needs survey – easy read – 17.01.11 learning...

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