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Thank you for visiting this page. This questionnaire is part of a National Clinical Audit
which aims to improve the quality of care that hospitals provide to people who have
confusion or memory problems.

We would like this questionnaire to be completed by family carers or key worker carers
who visited the person with memory problems during their admission to a general hospital.

We invite you to share your views about the care received by the person you care for and
about the communication you have had with staff at the hospital. The information that you
give will be used to help the hospital, and other hospitals, improve standards of care by
highlighting things that are done well and areas that need improvement. We welcome any
feedback and comments about the care and support provided.

The questionnaire contains 17 non-mandatory questions so you can answer as many or
as few of the questions as you like. It should take no longer than 15 minutes to complete.
After you have completed the questionnaire, you can enter a prize draw to win one of five
£50 vouchers for a high street store of your choice. To enter, you will need to follow the
instructions at the end of the questionnaire. The answers you provide to the questionnaire
cannot be linked to your prize draw entry.

The questionnaire does not ask for your name, so all the information you give us will be
completely anonymous. Reports will be published in 2019 and will include compiled
anonymous feedback and comments. If you tell us about a risk of harm to a patient,
we may need to contact the hospital straight away.

If you have any questions about the National Clinical Audit, please contact the Project
Team on 020 3701 2682 (9am to 5pm) or at

You can also visit the website at

If you decide that you would prefer not to fill in the questionnaire, this is fine and will
not in any way affect the care provided to the person you care for.
© HQIP 2018
Carer views on the quality of hospital care
Please enter the name of the hospital, and the town or city the hospital is in,
where the person you care for was treated:
Please note this must be the hospital name, and not the name of the trust which the
hospital belongs to. We will not be able to use your feedback unless we have this