The Department of Health are conducting this questionnaire to gather perceptions about the current provision of dementia services available in the South West and how to improve these services. We would appreciate you completing the following questions if you suffer from, know someone affected by or care for someone with dementia. For each section, click on the appropriate box to give your answer and on the final page there is a 'Submit' button. Please submit all replies by 1 September, 2009. (Definition of dementia includes: Alzheimer's disease, vascular disease and Lewy-body disease). Section 1. Introduction Q1 Please tick one of the following:   I suffer from dementia I am filling in this questionnaire for someone else who suffers from dementia and they have given permission for me to do so I have a family member / friend / neighbour who suffers from dementia. I am the main carer I have a family member / friend / neighbour who suffers from dementia. I am not the main carer I care voluntarily for someone (not family / friend / neighbour) with dementia I used to care voluntarily for someone with dementia I am employed to care for 1 or more people with dementia I used to be employed as a carer for someone with dementia

Q2 How long has dementia been diagnosed for yourself, the person you know affected by dementia, the person you care for or the person you are filling in this questionnaire for?   More than 5 years 3-5 years 1-2 years Last 12 months Not diagnosed Don't know / Don't wish to answer

Section 2. Provision of Information and Advice Q3 To what extent do you agree with the following statements about the provision of information and advice about dementia services. Do you think information and advice ...?   Strongly agree   Agree   Disagree   Strongly disagree   Don't know   Is easy to find           Is easy to understand           Is helpful           Fulfils what you need to know         Q4 When you were first affected by dementia (as a sufferer, because someone you know was a sufferer or you became a carer) how useful was the information/advice about dementia services you received from the following?   Very useful   Quite useful   Not useful   Not used   GP         Community Nurse         Charities         Websites         Library         Friend / Family / Neighbour         Books         Other (please state in question 5)

Q5 Please state 'Other' sources of information and advice you received (from question 4) and how useful they were (very / quite useful / not useful)

Section 3. Quality of Support Services Q6 If you, or the person you know/care for with dementia, have ever received any of the following support services, how would you rate the quality of the service?   Excellent   Good   Poor   Never received & don't need this although it is available locally   Never received & don't need this & not available locally   Never received but need this & it is available locally   Never received & need this but it is not available locally   GP               Community nurse               Home care services               Sheltered housing               Alarm system / Telecare               Day centre               Memory cafe               Drop-in-support groups / activity groups               Respite care               Other (please state in question 7)

Q7 Please state 'Other' sources of support (from question 6) you received and whether you rate them (excellent, good or poor). Q8 Which of the following providers do you feel require more training on dementia?   Yes   No   Don't use   GP       Community nurse       Home care services       Sheltered housing       Alarm system / Telecare providers       Day centre       Memory cafe       Drop-in-support / activity groups       Respite care       Other (please state in questin 9)     Q9 Please state 'Other' providers (from question 8) that you feel may require more training on dementia.

Section 4. Quality of Care for People with Dementia in General Hospitals Q10 To what extent do you agree with the following statements about the quality of care for people with dementia in general hospitals?   Strongly agree   Agree   Disagree   Strongly disagree   No opinion / Never affected me   The sharing of information between GP surgeries, social services and hospitals needs to improve           There needs to be better training for hospital staff about dementia           There needs to be better communication about dementia with relatives of those in hospital           Not enough attention is given to hospital patients' personal needs (i.e. eating, drinking etc)           More care is required for hospital patients' personal property (i.e. clothing, dentures, hearing aids etc)           Transportation arrangements for patients after hospital treatment is completed needs to be improved           More help is needed when dementia patients return home from hospital

Section 5. Quality of Care for People with Dementia in Care Homes Q11 To what extent do you agree with the following statements about the quality of care for people with dementia in care homes?   Strongly agree   Agree   Disagree   Strongly disagree   No opinion / Never affected me   There needs to be more staff training about dementia for those working in care homes           More community health services (i.e. chiropody) need to be available to those suffering from dementia in care homes           The use of anti-psychotic drugs should be cut down for those with dementia in care homes           There should be better NHS dental services available for those suffering from dementia in care homes           More engaging activities should be introduced into care homes for dementia sufferers

Q12 Do you have any further comments regarding dementia services?

Section 6. Demographics - optional (All answers are to be aggregated for research and analysis purposes only) Q13 Age range: (If completing this for multiple sufferers - leave blank)   0-15   16-24   25-34   35-44   45-54   55-64   65-74   75-84   85+   Of the person suffering from dementia                   Of the person completing the form (if not a sufferer)                 Q14 Gender: (If completing this for multiple sufferers - leave blank)   Male   Female   Of the person suffering from dementia     Of the person completing the form (if not a sufferer)

Q15 Postcode: Of the person suffering from dementia Q16 Postcode: Of the person completing the questionnaire (if not a sufferer) All answers will be treated in the strictest confidence. The information will be aggregated for research puposes only. It will not be used for marketing purposes by any parties. No contact will be made with individuals. Please note there will also be a printed version of this questionnaire appearing in local newspapers and on a leaflet. You do not need to fill in more than one version. Thank you for your time - please click on the 'submit' button to complete this questionnaire.