[PET - 011] Patient Experience Team - Complaints Process Survey

We would like to understand your experience of making a complaint to Harrogate & District NHS Foundation Trust (HDFT).

Results from this survey will be used to make improvements to the complaints process and how HDFT responds to complaints. Results of this survey are confidential and will only be shared with the Patient Experience Team for the purpose of making improvements to the complaints process.

The questionnaire is for people who have raised a complaint about their experience of the care/service provided by HDFT within the past 12 months.

The person who made the complaint should complete the form. Please contact the Patient Experience Team if you require any assistance:

- Email: hdft.patientexperience@nhs.net

- Post: Patient Experience Team Office, Harrogate District Hospital, Lancaster Park Road, Harrogate, HG2 7SX
- Phone: 01423 555499

Question Title

* 1. Complaint Reference Number (if known)

Tell us a little about yourself?

Why are we asking? By finding out more about you, we can ensure our services meet the needs of everyone

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* 2. How old are you?

16-24

25-34

35-44

45-54

55-64

65-74

75-84

85-94

95 and above

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* 3. What is your gender?

Male

Female

Trans-Male

Trans-Female

Intersex

Non-binary

Prefer not to say

If you prefer to use your own gender identity, please state below:

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* 4. Do you have a disability?

Yes

Prefer Not to Say

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* 5. Please indicate your ethnicity

White/British

White/Irish

White/Gypsy or Irish Traveller

Other White

Black/Caribbean

Black/African

Other Black

Mixed/White and Black Caribbean

Mixed White and Black African

Mixed/White and Asian

Other Mixed

Asian/Indian

Asian/Bangladeshi

Asian/Chinese

Other Asian

Other Arab

Other

Prefer not to say

Question Title

* 6. Communications:

	Yes	No	I'm Not Sure
Did you know who to contact to make your complaint?	Did you know who to contact to make your complaint? Yes	Did you know who to contact to make your complaint? No	Did you know who to contact to make your complaint? I'm Not Sure
Did you receive a phone call or an email from the Patient Experience Team (PET) to acknowledge receipt of your complaint?	Did you receive a phone call or an email from the Patient Experience Team (PET) to acknowledge receipt of your complaint? Yes	Did you receive a phone call or an email from the Patient Experience Team (PET) to acknowledge receipt of your complaint? No	Did you receive a phone call or an email from the Patient Experience Team (PET) to acknowledge receipt of your complaint? I'm Not Sure
Did the PET officer record an accurate summary of your complaint in the form of the Triage And Resolution Plan (TARP)?	Did the PET officer record an accurate summary of your complaint in the form of the Triage And Resolution Plan (TARP)? Yes	Did the PET officer record an accurate summary of your complaint in the form of the Triage And Resolution Plan (TARP)? No	Did the PET officer record an accurate summary of your complaint in the form of the Triage And Resolution Plan (TARP)? I'm Not Sure

Comments:

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* 7. Investigation:

	Yes	No	I'm Not Sure
Did the Lead Investigator make contact with you, at the beginning of the complaint investigation to discuss your concerns and the complaints process?	Did the Lead Investigator make contact with you, at the beginning of the complaint investigation to discuss your concerns and the complaints process? Yes	Did the Lead Investigator make contact with you, at the beginning of the complaint investigation to discuss your concerns and the complaints process? No	Did the Lead Investigator make contact with you, at the beginning of the complaint investigation to discuss your concerns and the complaints process? I'm Not Sure
Did you feel you were provided with enough updates regarding your complaint?	Did you feel you were provided with enough updates regarding your complaint? Yes	Did you feel you were provided with enough updates regarding your complaint? No	Did you feel you were provided with enough updates regarding your complaint? I'm Not Sure

Comments

Question Title

* 8. Response and Outcome:

	Yes	No	I'm Not Sure
Did you receive a written response?	Did you receive a written response? Yes	Did you receive a written response? No	Did you receive a written response? I'm Not Sure
Did you attend a face to face meeting?	Did you attend a face to face meeting? Yes	Did you attend a face to face meeting? No	Did you attend a face to face meeting? I'm Not Sure
Did you receive your response within agreed timeframe?	Did you receive your response within agreed timeframe? Yes	Did you receive your response within agreed timeframe? No	Did you receive your response within agreed timeframe? I'm Not Sure
If you did not receive your response within the agreed timeframe, were you informed that there would be a delay and why?	If you did not receive your response within the agreed timeframe, were you informed that there would be a delay and why? Yes	If you did not receive your response within the agreed timeframe, were you informed that there would be a delay and why? No	If you did not receive your response within the agreed timeframe, were you informed that there would be a delay and why? I'm Not Sure
Were you given details of who to contact if you were not happy with the response?	Were you given details of who to contact if you were not happy with the response? Yes	Were you given details of who to contact if you were not happy with the response? No	Were you given details of who to contact if you were not happy with the response? I'm Not Sure
Were you given any actions / explanations of how your complaint would be used to improve services?	Were you given any actions / explanations of how your complaint would be used to improve services? Yes	Were you given any actions / explanations of how your complaint would be used to improve services? No	Were you given any actions / explanations of how your complaint would be used to improve services? I'm Not Sure
Did you find the response open & honest?	Did you find the response open & honest? Yes	Did you find the response open & honest? No	Did you find the response open & honest? I'm Not Sure
Was the final response to your complaint easy to understand?	Was the final response to your complaint easy to understand? Yes	Was the final response to your complaint easy to understand? No	Was the final response to your complaint easy to understand? I'm Not Sure
Did the response answer all of your questions / provide all the information you requested?	Did the response answer all of your questions / provide all the information you requested? Yes	Did the response answer all of your questions / provide all the information you requested? No	Did the response answer all of your questions / provide all the information you requested? I'm Not Sure

Comments:

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* 9. How Easy & Accessible did you find the process to make your complaint?

Very Easy & Accessible

Somewhat Easy & Accessible

Neutral

Somewhat Difficult and Inaccessible

Very Difficult and Inaccessible

Comments:

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* 10. How satisfied with the outcome of the complaint process?

Very Satisfied

Somewhat Satisfied

Neutral

Unsatisfied

Very Unsatisfied

I'm Not Sure

Comments:

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* 11. How did you feel treated during your complaints process?

	I Agree	I Disagree	I'm Not Sure
With Dignity	With Dignity I Agree	With Dignity I Disagree	With Dignity I'm Not Sure
Respectfully	Respectfully I Agree	Respectfully I Disagree	Respectfully I'm Not Sure
Sensitively	Sensitively I Agree	Sensitively I Disagree	Sensitively I'm Not Sure
My feedback, experience & complaint was welcomed	My feedback, experience & complaint was welcomed I Agree	My feedback, experience & complaint was welcomed I Disagree	My feedback, experience & complaint was welcomed I'm Not Sure
Confident in the process	Confident in the process I Agree	Confident in the process I Disagree	Confident in the process I'm Not Sure
I trusted the staff involved with my complaint	I trusted the staff involved with my complaint I Agree	I trusted the staff involved with my complaint I Disagree	I trusted the staff involved with my complaint I'm Not Sure

Comments:

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* 12. Did you feel reassured that your future care would not be negatively impacted when accessing the Complaints Process?

Very Reassured

Somewhat Reassured

Neutral

Not so Reassured

Not at all Reassured

I'm Not Sure

Comments:

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* 13. Would you feel confident to raise another complaint, if needed, in the future?

Very Confident

Somewhat Confident

Neutral

Unconfident

Very Unconfident

I'm Not Sure

Comments: