Welcome to the stakeholder engagement survey for Joint Strategic Needs Assessment (JSNA): Dementia. A JSNA is a report that will help us to plan future services for Dementia. It tells us what works well and what we might need to improve.

This survey is your chance to tell us your experience of living with Dementia in Wolverhampton.

We can also provide a summary of findings from the survey upon request. All survey responses will be kept confidential and no identifiable information will be collected.

If you need any further information regarding the survey, please contact Parmdip Dhillon, by email: parmdip.dhillon@wolverhampton.gov.uk or by phone: 01902 551846.

We would appreciate all surveys to be completed by 5th January 2018.

Thank you.

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* 1. Are you living well with Dementia?

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* 2. What is your type of residency?

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* 3. Do you have enough family and friends around you that you can count on for support?

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* 4. Are you receiving any support to live well with Dementia?

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* 5. Do you feel involved enough in decisions about your care and support?

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* 6. If you have a carer (family or friend), do they receive help to care for you?

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* 7. How long ago were you diagnosed with Dementia?

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* 8. How would you rate your experiences of the services involved with your diagnosis?

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* 9. Have you used a Dementia Cafe over the past three years?

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* 10. If so, how often do you use the Dementia Cafe?

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* 11. If not, what stops you using a Dementia Cafe?

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* 12. Do you have any comments about Dementia Cafes? What is useful/not useful?

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* 13. If you feel well supported with your Dementia in your local area, please tell us why?

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* 14. In your general day to day life, are you able to make choices about how you spend your time?

To complete this survey, we would like to ask the following set of questions because it will help us understand your answers and to ascertain whether the current Dementia services provided in Wolverhampton are fair and accessible to a diverse range of people with dementia.

Under the Equality Act 2010, the council has a responsibility to ensure that we do not unfairly discriminate in the services we provide and to ensure that our Equal Opportunities policy is working. Providing the information below is optional, but this information will be treated in the strictest confidence and will only be used for statistical monitoring, to help ensure services are accessible and caters for the needs of all people with Dementia and those that cares for them.

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* 15. What is your gender?

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* 16. How old are you?

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* 17. What is your marital status?

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* 18. What is your ethnicity?

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* 19. Which religion do you belong to?

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* 20. Which of the following describes your sexuality?

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