1. Welcome to the survey
Gloucestershire County Council is reviewing the services that it commissions for carers from the
black and minority ethnic community.
Equinox Consulting have been asked to undertake a survey of carers with a view to making
recommendations on how best the service should be designed to assist carers with their caring
roles.
We are asking that you participate in this survey that will take about 30 minutes of your time. We
believe that the valuable information you provide will help us to better understand how to support
you in your caring role.
*A Carer is anyone who cares, unpaid for family member or friend who due to illness, disability, a
mental health problem or an addiction cannot cope without their support.
2. Carer Profile
1. Do you spend time providing unpaid support to a family member, partner, or friend who is ill, frail,
disabled or has mental health or substance abuse problems, who would not be able to cope without your
support?
Yes
No
2. What is your ethnic origin?
White
Mixed
Asian
Black
Other
Ethnicity
Other (please specify)
3. Which Council do you pay your council tax to?
Cheltenham
Stroud
Cotswold
Gloucester
Tewkesbury
Forest of Dean
Other (please specify)
3. Caring duties
4. What is the gender of the person you are caring for?
Male
Female
Transgender
5. How old are they?
<5
6-17
18-25
26-44
45-64
65-79
80+
1
6. Why do they need your care?
Learning
disabilities
Substance
abuse
Mental
health issues
Physical
Old and frail
disabilities
Ill and end
of life
Ill with long
term condition
Other (please specify)
7. What is your relationship to them?
Parent
Child
Sibling
Friend
other relative
Spouse/Partner
8. How long have you been caring for them?
under 3 months
4 - 12 months
1 - 2 years
3- 5 years
over 5 years
9. Why are you the person providing care for them?
10. How many hours a week do you care for them?
1-19
20-34
35-49
50+
11. Please describe the type of support that you provide for the person you support and care for
12. Does anyone else assist you with the care that you provide?
Yes
No
13. Does a paid care worker also provide services to the person you look after?
Yes
No
4. Your Support Needs
We would like to hear how providing the care and support affects you and if there is any way you
can be assisted in your role.
14. How does your caring role affect your normal life and day to day activities?
15. What are the THREE most important ways that the caring role affects your life?
1
2
3
2
16. What things would you like to do but you are unable to do because of your caring responsibilities?
17. What would make a positive difference to your caring role?
18. Have you ever sought assistance from anyone relating to your care role?
Yes
No
19. Please explain why you have not sought any support?
20. Who have you asked for assistance relating to your caring role?
1
2
3
21. How did you find out about the fact that help was available?
GP
Family
Newspaper
Local Authority
Leaflet
Carer Organisation
Community group
Advert
Friend
Radio
Other (please specify)
5. Services Received
22. which organisations provide you with services?
Short breaks
Respite
Information
Advice
Training and education
toolkits for caring skills
emotional support
financial allowances
3
23. How have these services helped you in your role as a carer?
6. Carers Assessment
24. Have you received carers assessment?
Yes
No
25. Did you receive assistance in planning the support that you needed?
Yes
No
26. Which organisations provide you with assessment and support planning
1
2
3
27. How would you rate the assessment and support planning you received?
excellent
good
satisfactory
poor
28. What would have improved your experience of assessment and support planning?
7. Access to information
29. Have you used information and advice services?
Yes
No
30. Which organisations provided you with information and advice
1
2
3
31. How would you rate the information and advice you receive?
excellent
good
satisfactory
poor
32. What additional information and advice would you find useful?
1
2
3
4
8. Having a break from Caring
33. Do you receive a carers break?
Yes
No
34. Which is the main organisation that provides you with a break?
35. How would you rate the carer breaks you receive?
excellent
good
satisfactory
poor
36. Please explain why you have given this rating
37. How could the breaks service you currently receive be improved?
9. Emotional Support
38. Have you used an emotional support service. e.g.counselling, carer support group or support from
another person?
Yes
No
39. Which is the main organisation that provided you with emotional support?
40. How would you rate the emotional support you receive?
excellent
good
satisfactory
poor
41. How can the emotional support you receive be improved?
10. Hearing your Views
Every carer has a right to have their views heard to influence decisions and to influence the
services that are developed for carers
42. Do you get any support to have your views heard?
Yes
No
5
43. If Yes, state which organisations assist you?
1
2
3
44. If No, what stops you from having your views heard?
45. How would you rate the support you receive to have your views heard?
excellent
good
satisfactory
poor
46. How can the support you receive to have your views heard be improved?
11. Additional support issues
47. Do you belong to any networking or support organisation?
Yes
No
48. If Yes, please tell us the main ones you belong to
1
2
3
49. What happens when you are not able to provide the care you usually do?
I am registered on the Carers Emergency Scheme
I make my own arrangements
50. Please explain the reasons for your choice
51. What are the three most important services that you receive?
1
2
3
6
52. How would you rate the services you receive?
excellent
good
satisfactory
poor
1
2
3
53. What further support would help you in your caring role?
54. Is the ethnicity or religion of the person who supports you important to you?
Very important
Important
fairly important
Not important
55. Why is this?
12. Demographics
56. How old are you?
<8
8-11
12-17
18-25
26-44
45-64
65-79
80+
57. What is your gender?
Female
Male
Transgender
58. Which of the following best describes your current marital status?
Married
In a domestic partnership or civil union
Widowed
Single, but cohabiting with a significant other
Divorced
Single, never married
Separated
59. How many children do you have?
Dependant
Non-dependant
60. Which of the following categories best describes your employment status?
Employed, working full-time
Not employed, NOT looking for work
Employed, working part-time
Retired
Not employed, looking for work
Not able to work due to disability
7
61. What is your religion?
Christian
Buddhist
Sikh
Muslim
Jewish
None
Rastafari
Hindu
would prefer not to say
Other (please specify)
62. How would you describe your sexual orientation?
Heterosexual
Gay/Bisexual
Prefer not to say
63. Would you like to be contacted to participate in a focus group or in-depth interview?
Yes
No
64. Please provide us with your contact details
Name
Address
PostCode
Telephone Number
Email address
8