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JOIN THE PEOPLE'S PANEL
People’s Panel members who complete surveys:
▪ are entered into a prize draw for each survey
▪ have the chance to tell us what they think about things that affect them, their
▪ neighbourhood and their city or town
▪ help make sure that the council, NHS Hull CCG, and others like the police and fire
▪ service listen to their views
▪ will be included in special prize draws if they complete all of the surveys we send
▪ them
If you'd like this survey in another format or language, or if you have any questions
about this survey or the People’s Panel in general, please contact us using the details
listed below.
You can complete an online recruitment form at: www.hullcc.gov.uk/peoplespanel
The People’s Panel is a partnership between Hull City Council and NHS Hull Clinical
Commissioning Group
Contact Details
Please provide your contact details so that we can send you surveys.
We need your full postal address so we can send you your prize if you win one of our prize draws. We
will not pass your details on to anyone else without your permission.
First name......................... ....
Surname ........................... ....
Email address ................... ....
Address Line 1.................. ....
Address Line 2.................. ....
City/Town.......................... ....
Postcode........................... ....
Home telephone ............... ....
Mobile telephone .............. ....
Please provide your home postcode if different to above. People's Panel members often help the
council, the NHS and the police to understand local neighbourhood issues (such as community safety
priorities). We use postcodes to understand where different responses come from. We won't attach
your name or full address to your survey responses.
It is 65 times cheaper for us to contact you online than by post. As an online member, we will
send you online surveys by email. You will also be able to take part in more consultations and
give your views about more things. However, we understand that not everyone has access to the
internet. If you require your surveys by post, please tick this box.
If you need another format or language please specify below.
People's Panel Champions
The People's Panel team are looking for members who would like to become champions.
People's Panel champions get involved in lots of different ways, such as helping to test questionnaires
and newsletters to make sure they are accessible, and making the People's Panel bigger and better by
helping us recruit new members, especially from groups that don't often get the chance to be heard,
such as younger people or those with learning difficulties.
In return, People's Panel champions will be offered incentives, such as V.I.P tickets to events (for
example, exhibitions at museums and galleries), free tickets to council facilities such as the Ice Arena,
go carting or leisure centres as well as the opportunity learn new skills.
Are you interested in becoming a People's Panel champion? Please tick one box
Yes, please send me information
No, I am not interested
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Public Sector Staff
Public sector organisations are some of the largest employers in the region. Public sector staff are
encouraged to join the People's Panel and give us their views as residents. However, sometimes we
would like to understand where their views differ from others. Please remember, the information you
provide will be kept confidential.
Which of the following best describes you? Tick one box
I don't work in the public sector
I work for Hull City Council or East Riding of
Yorkshire Council
I work for the NHS
I work for another public sector organisation
You and Your Household
The following questions are about you and your household. Your answers help us to make sure that
members of the People’s Panel represent the local population, to understand the views of different
groups and to deliver all our services fairly.
We may contact People's Panel members to take part in activities or consultations that may be
relevant or of interest to them. For example, we may want to consult specifically about services for
older people.
You don't have to answer these questions. Any questions you don't wish to answer, please leave the
boxes blank. The information you provide will be kept completely confidential.
1
What is your gender/gender identity?
Please tick one box
Male
Female
If there is anything else about your gender/gender identity you wish to tell us, please use the
space below.
2
What year were you born? (YYYY)
3a
Are your day-to-day activities limited because of a health problem or an impairment which
has lasted, or is expected to last, at least 12 months? Please include conditions such as
mental health issues or those related to ageing. Please tick one box
Yes, limited a little
3b
No
Does anyone else in your household feel that their day-to-day activities are limited because
of a health problem or an impairment which has lasted, or is expected to last, at least 12
months? Please include conditions such as mental health issues or those related to ageing
Please tick one box
Yes
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Yes, limited a lot
No
Which of the following best describes your ethnic background? Please tick one box
White British
Asian/Asian British
White other
Mixed/multiple ethnic group
Black/Black British
Other (please specify below)
3
5
How many adults and children live in your household including yourself? If there are no
children in your household please enter a 0.
Number of adults aged 16 and over (including yourself):................................................
Number of children aged 15 or under (if none, please enter a 0): ..................................
6a
6b
Do you provide or receive unpaid care? By unpaid care we mean: regularly looking after or
giving help or support to others, either in or outside of your home, because of a health problem or
impairment (including mental health issues or any related to ageing). Do not include anything that
you would usually do as part of your paid employment. Please tick all that apply
I provide unpaid care for someone
Go to 7
I receive unpaid care from someone
Go to 6b
I don't provide or receive unpaid care
Go to 7
Is the person that you receive unpaid care from aged 18 or younger? Please tick one box
Yes
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No
Do you currently volunteer? This can be any activity that involves spending unpaid time doing
something that benefits the environment, individuals or groups. It can cover a range of activities
from formal volunteering for an organisation, to helping out in the community by doing things such
as picking up litter, taking the school sports team to and from matches, or regularly doing odd jobs
for a vulnerable neighbour. Please tick all that apply
No I don't volunteer, and I am unlikely to in future
No I don't volunteer, but I would like to in future
Yes, I do formal volunteering for a voluntary organisation
Yes, I do formal volunteering for another type of organisation
Yes, I volunteer to gain work experience
Yes, I do informal volunteering (for example, helping out in the community)
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Is there anything else you would like to tell us about yourself? Some examples of things
people have told us are that they are transgender, the different languages they speak, community
groups they are involved in or volunteer work they do or would like to try. Please use the space
below
Thank you very much for taking the time to complete this recruitment form. Once we have
received this information you will be a member of the People's Panel and will be sent the next
survey. We look forward to hearing your views when the next People's Panel survey goes out.
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