diabetes, chronic heart disease, or epilepsy d. BLACK / AFRICAN / CARIBBEAN / BLACK Go to 52 BRITISH African No, I do not have a long-standing condition 14 8 Caribbean Go to 53 15 Any other Black / African / Caribbean 16 Does this condition(s) cause you difficulty with background, write in... any of the following? (CROSS ALL THAT APPLY) Everyday activities that people your age can 1 usually do e. OTHER ETHNIC GROUP At work, in education or training Arab 2 17 Any other ethnic group, Access to buildings, streets or vehicles 18 3 write in... Reading or writing 4 to you because of your People’s attitudes 5 ANY OTHER COMMENTS condition Communicating, mixing with others or 6 If there is anything else you would like to tell us socialising about your experiences in the emergency Any other activity department, please do so here. 7 No difficulty with any of these Please note that the comments you provide in the 8 box below will be looked at in full by the NHS Trust, CQC and researchers analysing the data. We will remove any information that could identify you before publishing any of your feedback. To which of these ethnic groups would you say you belong? (Cross ONE only) a. WHITE English/Welsh/Scottish/Northern Irish/ 1 British Irish 2 Gypsy or Irish Traveller 3 Any other White background, 4 write in... b. MIXED / MULTIPLE ETHNIC GROUPS White and Black Caribbean 5 White and Black African 6 White and Asian 7 Any other Mixed/multiple ethnic 8 background, write in... c. ASIAN / ASIAN BRITISH Indian 9 Pakistani 10 Bangladeshi 11 Chinese 12 Any other Asian background, 13 write in...
diabetes, chronic heart disease, or epilepsy Go to 52 8 No, I do not have a long-standing condition Go to 53 Does this condition(s) cause you difficulty with any of the following? (CROSS ALL THAT APPLY) 1 Everyday activities that people your age can usually do 2 At work, in education or training 3 Access to buildings, streets or vehicles 4 Reading or writing 5 People’s attitudes to you because of your condition 6 Communicating, mixing with others or socialising 7 Any other activity 8 No difficulty with any of these To which of these ethnic groups would you say you belong? (Cross ONE only) a. WHITE 1 English/Welsh/Scottish/Northern Irish/ British 2 Irish 3 Gypsy or Irish Traveller 4 Any other White background, write in... b. 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, write in... c. ASIAN / ASIAN BRITISH 9 Indian 10 Pakistani 11 Bangladeshi 12 Chinese 13 Any other Asian background, write in... d. BLACK / AFRICAN / CARIBBEAN / BLACK BRITISH 14 African 15 Caribbean 16 Any other Black / African / Caribbean background, write in... e. OTHER ETHNIC GROUP 17 Arab 18 Any other ethnic group, write in... ANY OTHER COMMENTS If there is anything else you would like to tell us about your experiences in the emergency department, please do so here. Please note that the comments you provide in the box below will be looked at in full by the NHS Trust, CQC and researchers analysing the data. We will remove any information that could identify you before publishing any of your feedback.