Maternity FFT Survey

Putting our patients first and ensuring we improve the quality of care is our main priority, this means listening and acting on your concerns. Please help us to improve our services by completing this short survey questionnaire about your experience of our services, it is free and will only take a few minutes of your time. Thank you.

Please choose the service you visited:

1. Thinking about your recent experience with us, Overall, how was your experience of our service?

Very good Good Neither good nor poor Poor Very poor Don't know

2. Please tell us what was good about your care?

4000 characters remaining

Can we share your comment publicly (for example, on our website or printed material such as posters)?

Yes No

3. Please tell us what could have been improved?

4000 characters remaining

Can we share your comment publicly (for example, on our website or printed material such as posters)?

Yes No

4. Were you treated with dignity, respect and kindness?

Yes Sometimes No Don't know

5. Overall how clean and comfortable was the location or environment you were in?

Very Good Good Neither good nor poor Poor Very poor Don't know N/A

6. Did you get enough help from the staff when you needed it?

Yes Sometimes No Don't know

Did you have confidence in the staff looking after you?

	Yes	Sometimes	No	Don't know
7. Midwives
Notes:
8. Care support workers
Notes:

7. Midwives

Yes Sometimes No Don't know

8. Care support workers

Yes Sometimes No Don't know

9. Doctors

Yes Sometimes No Don't know N/A

	Yes	Sometimes	No	Don't know	N/A
9. Doctors
Notes:
10. Other staff
Notes:

10. Other staff

Yes Sometimes No Don't know N/A

11. Were you (and / or your partner or companion) left alone by midwives or doctors at a time when it worried you?

No Yes Don't know

12. Did you feel involved enough in the decisions made about you?

Yes Sometimes No Don't know

13. Have you had your baby?

Yes No

14. If your partner or someone else close to you was involved in your care during labour and birth, were they able to be involved as much as they wanted?

Yes No Don't know

15. During labour and birth, did staff help to create a more comfortable atmosphere for you in a way you wanted?

Yes Sometimes No Don't know

16. Did you have skin to skin contact (baby naked, directly on your chest or tummy) with your baby shortly after the birth?

Yes No Don't know

17. How would you rate the quality and range of food we provided?

Very Good Good Neither good nor poor Poor Very poor N/A

A little about you;

18. Which of the following options best describes how you identify yourself:

Male Female Non-binary Trans Man Trans Woman Other Prefer not to say

19. In which age group are you?

Under 18 18 - 25 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85 +

20. What do you consider to be your ethnic background?

White Mixed or multiple ethnic groups Asian or Asian British Black, Black British, Caribbean or African Other ethnic group Prefer not to say

21. Do you have any of the following conditions? (please tick all that apply)

A long standing physical condition A mental health condition A learning disability A long standing illness (e.g. asthma, diabetes, COPD, Cancer, Dementia, Heart disease) Blind or partially sighted Deafness or severe hearing impairment Other None of the above