Hospice At Home Service Evaluation

1. How quickly did the Hospice at Home team contact you once a referral had been made? (please tick where applicable)

Where 1 is "very slow" 10 is "very fast"

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2. How would you rate the communication you had with the Hospice at Home team? (please tick where applicable)

Where 1 is "very poor" 10 is "very good"

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3. Did you feel the team was able to support you/ your loved one in the way you needed? (please tick where
applicable)

Where 1 is "not at all" 10 is "always"

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4. Do you feel having the Hospice at Home team reduced any worries or anxiety that you may have had? (please tick
where applicable)

Where 1 is "not at all" 10 is "always"

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5. Do you feel the staff took the time to listen to your concerns/worries? (please tick where applicable)

Where 1 is "not at all" 10 is "always"

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6.Do you think you would have been able to care for your loved one at home without the help of the Hospice at Home
team? (please tick where applicable)

Where 1 is "not at all" 10 is "definitely"

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7.Without the support of the Hospice at Home team do you feel you would have needed more advice/support from other
services, such as (please tick where applicable)

GPHospital AdmissionDistrict NurseSpecialist Nurses111Other

The information you provide will be treated in the strictest confidence and only used for evaluation purposes. You do
not need to include your name and address unless you wish to do so.
To enable us to raise the funds needed for others to receive this services, we need more people to be made aware of
the work we do. Therefore, if you are willing for us to quote your comments in our publicity, please include your
name and contact details below so we may contact you in advance of any usage.

Your name

Your email

We would welcome any additional comments or suggestions you would like to make regarding Blythe House
Hospice at Home Service in partnership with Helen's Trust, as we are continuously aiming to improve our services.