Day Opportunities Consultation
Feedback Form - What will happen next?
Your views will be taken into account in the preparation of the final model which will go to Council’s
Cabinet for agreement in November 2013. After which the final model for day opportunities will be
published and this will form the basis for the future development of services.
Are you …….
- A user of day opportunities
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- A friend, relative or advocate of someone who uses day opportunities
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- Completing this feedback on behalf of an organisation
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- Other …………………………………………………………………………………………………………………………………
1. The proposed new model would mean that people will use their own personal budgets to
arrange day activities in the community, instead of attending what we call building based Day
Centres.
Do you agree or disagree that the proposed new model of providing day opportunities
instead of Day Centres will give people who use these services greater choice and control?
(Please tick one box)
1.
2.
3.
4.
5.
Strongly agree
Tend to agree
Neither agree nor disagree
Tend to disagree
Strongly disagree
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2. Looking at the number of people who will be opting out of using day centres, it is highly
likely that some of our in-house day centres will close, or at the very least service delivery
from these buildings will be different.
How do you think the proposed new model will affect the people and their family and friends
who go to these services currently?
…………………………………………………………………………………………………………………………………………………………………
3.Is the creation of a Hub type model where different activities take place and clients can pop
in for specific sessions something that you would like to see happen? (Please tick one box)
1.
2.
3.
4.
5.
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


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Strongly agree
Tend to agree
Neither agree nor disagree
Tend to disagree
Strongly disagree
4. As it is likely that only some of our current in-house Day Centres will remain under the new
proposed model, do you agree that any remaining in-house services should be developed to
meet the needs of those with very specialist needs?
1.
2.
3.
4.
5.
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



Strongly agree
Tend to agree
Neither agree nor disagree
Tend to disagree
Strongly disagree
5. Please tell us anything else you think the Council could do to improve the proposed new
model of providing day opportunities?
…………………………………………………………………………………………………………………………………………………………………
5. About you
We would now like to ask you some questions about yourself. These are important as they will help us
understand if there are any differences in opinion by different types of residents. We want to stress that
all you will say will be treated anonymously – this means that your personal details will not be reported
alongside your individual responses.
5a) Are you…? Please tick one box only
Female
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Male

Transgender
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5b) To which one of the following age groups do you belong? Please tick one box only
18-24

45-64

25-34

65-80

35-44

81 or over

5c) Do you consider yourself to have a long term illness, health problem or disability which limits your
daily activities or the work you do? Please tick one box only
Yes

No

5d) If “Yes”, please identify which type of disability from the options below
1. Hearing

2. Physical

3. Learning

4. Visual

5. Other, please describe………………………………………………………………….
5e) Do you have a mental health issue or are you a user of mental health services? Please tick one box
only
Yes

No

5f) What is your ethnic group?
Choose one option that best describes your ethnic group or background
White
1. English / Welsh / Scottish / Northern Irish / British

2. Irish

3. Gypsy or Irish Traveller

4. Any other White background, please describe………………………………
Mixed / Multiple ethnic groups
5. White and Black Caribbean

6. White and Black African

7. White and Asian

8. Any other Mixed / Multiple ethnic background, please describe………………………….
Asian / Asian British
9. Indian

10. Pakistani

11. Bangladeshi

12. Chinese

13. Any other Asian background, please describe ……………………………
Black / African / Caribbean / Black British
14. African
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15. Caribbean

16. Any other Black / African / Caribbean background, please describe………………………………
Other ethnic group
17. Arab
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18. Any other ethnic group, please describe…………………………………..
5g) What is your religion or belief?
Buddhist

Muslim

Christian

Sikh

Hindu

None

Jewish

Other, please specify………………………………..
5h) What is your sexual orientation?
Heterosexual/Straight 
Lesbian

Gay man

Bisexual

Not sure/Don’t know
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Please return to the address below by the 24th October 2013:
Day Opportunities Consultation
47 Gainsford Road
Walthamstow
E17 6QB