Helen & Douglas House Family Feedback Questionnaire 2026

Survey (FSB2026) - Helen & Douglas House Family Feedback Questionnaire 2026

Section A: Caring for you and your child

Section B: Helen House

Section C: Support in the community in the last two weeks of your child’s life

Section D: After-death care at Helen House

Section E: Post death and bereavement

Section F: Bereavement Support Services

40. Feedback for bereavement support services received

Please note: This form is for bereaved Helen & Douglas House families only. By giving feedback on your experience of being supported by Helen & Douglas House in the months before and following the death of your child, you’ll help us to develop and improve our services. yPlease reply by 31st May 2026, thank you. If you require any support or guidance when filling in this questionnaire, email [email protected] or call 01865 794749.

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Your unique code (this can be found in the letter/email received) if not known, leave blank:

Date(Required)

DD slash MM slash YYYY

1. Did your child receive any care and support from Helen & Douglas House prior to their death?

Yes

No - please proceed to Section C

2. Did your child stay in Helen & Douglas House in the three months prior to their death?

Yes

Yes - more than once

No - our own preference

No - we were not offered this

3. Did your child receive nursing/medical support from Helen & Douglas House whilst not at the hospice, for example in the community; at home, in hospital, or in another setting?

Yes

No - our own preference

No - we were not offered this

Please answer these questions about your experience of Helen & Douglas House care

4. Was your child treated with respect and dignity by the hospice doctors, nurses and care staff?

Always

Most of the time

Some of the time

Never

Other

5. Did the hospice doctors, nurses and care staff explain your child’s care and treatment in a way that you find easy or difficult to understand?

Very easy

Fairly easy

Fairly difficult

Very difficult

I have never spoken to a doctor/nurse

Other

6. Were you/other family members kept informed about your child’s condition?

Always

Usually

Sometimes

Never

Don't know

7. How well did we work together with your child’s specialist teams and other services outside of the hospice?

Yes, definitely worked well together

Yes, to some extent

Not applicable

8. Were you/your child involved in decisions made around their care and treatment?

Yes

Don't know

9. If your child experienced pain, how well was this pain addressed?

Does not apply

All of the time

Some of the time

Partially

Not at all

Don’t know

Not applicable

10. How well were your child’s symptoms addressed, other than pain?

Does not apply

Completely, all of the time

Completely, some of the time

Partially

Not at all

Don't know

11. Was our 24/7 telephone support line available at all times when you needed it?

Does not apply

All of the time

Some of the time

Partially

Not at all

I didn’t know this was available

12. Did you/your child/family feel supported by Helen & Douglas House in the following areas:

13. Where did your child die?

Own home - after question 15, go to section C

Hospital - after question 15, go to section C

Helen & Douglas House - after question 15, go to section B

Any other community setting - after question 15, go to section C

14. What this your preferred place of death?

Yes

No, due to circumstances

No, due to lack of choice

Not sure

15. On reflection, do you think your child died in the right place?

Yes

Not sure

15. 1 Please write any other comments about this here:

16. Approximately, how long was your child's last hospice stay?

Up to 24 hours

24 - 72 hours

Longer than 72 hours

Not applicable - if so, go to Section C

17. Was there enough help available to meet your child’s personal care needs such as washing, personal hygiene and toileting needs?

All of the time

Some of the time

Partially

Not at all

Don't know

18. Was there enough help with nursing care, such as giving medicine and helping him/her to find a comfortable position in bed?

All of the time

Some of the time

Partially

Not at all

Don't know

19. Did the bed areas and surrounding environment provide adequate privacy for your child and family?

Yes, definitely

Yes, to some extent

No, not when I needed it

No, but I did not need this type of help

Don’t know

20. Did you stay in the hospice overnight at any time during his/her stay at the hospice?

Yes, found it helpful

Yes, but did not find it helpful

No, but I would have liked to stay

No, but I did not want to stay

Other

21. If you came to stay, did we give you the time and space to just be a parent and to make precious memories together?

Yes, definitely

Yes, to some extent

Not sure

22. Were you given enough help and support by the staff team at the actual time of his/her death?

Yes, definitely

Yes, to some extent

Not sure

23. How comfortable and clean you think the hospice is/was?

24. What support did you receive from our Outreach team (doctors and nurses)? Please tick as many as apply.

Telephone support

Visit - support

Email support

Phone messaging support (text)

None

25. If you received a visit in the community, how many visits did you have?

One visit

Two to three visits

Four or more visits

Not applicable

26. Were you able to access Outreach support from Helen & Douglas House when you needed it?

Yes, definitely

Yes, to some extent

No, not when I needed it

No, but I did not need this type of help

Don’t know

Not required

27. How useful was our Outreach support in managing your child’s symptoms - including pain?

Exceptionally useful

Somewhat useful

Not sure

Not very useful

Not useful at all

28. How useful was our Outreach support in providing confidence to have your child’s end-of-life care in the community?

Exceptionally useful

Somewhat useful

Not sure

Not very useful

Not useful at all

29. How useful was our Outreach support in preparing you to understand the end-of-life phase?

Exceptionally useful

Somewhat useful

Not sure

Not very useful

Not useful at all

Please answer these questions about after-death care, even if your child died elsewhere and was transferred to us to receive care after death.

30. What options were you given in terms of where your child could be cared for after they had died? Tick all that apply.

Hospital

Helen & Douglas House

Your own home

A place of worship

Not applicable

Other

31. Did your child receive after-death care from Helen & Douglas House?

Yes, continue to Question 32

No, continue to Section E

32. How long was your child cared for at Helen House?

Less than 24 hours

One to three days

Four days plus

33. Did you feel this was long enough?

Yes

Not sure

33.1 Please write any other comments about this here:

34. Was your child looked after with dignity and respect?

Completely, all of the time

Some of the time

Partially

Not at all

Not applicable

35. Were you offered religious/spiritual support by hospice staff, or given the choice to be supported by someone outside of the organisation?

Yes, we were supported by hospice staff

Yes, we chose to be supported by someone else

No, we didn't wish to have support

No, we weren't offered any support

36. As a family, how well were..

	Exceptionally well	Very well	Fairly well	Not very well	Not at all	Not required
…your physical needs met?
…your emotional needs met?
...you supported with the practical aspects of after-death e.g. funeral directors, medical examiner

Please answer the following questions on your experience post-death and during bereavement.

37. In bereavement, we understand that support can come from many different sources. What support did you find helpful? Tick all that apply.

Support from friends/family

Support from my community

Support from another bereavement charity

Support from another hospice/hospital

Support from my GP/other healthcare professionals

38. We currently make contact with families to offer bereavement support around six weeks after the death of their child. Was this the right time for us to make contact?

Yes

No, would prefer earlier

No, would prefer later

Other

39. Have you used bereavement support from Helen & Douglas House?

Yes - Please continue

No, my own choice - Please go to question 41

No, I didn’t know this was available - Please go to question 41

Yes definitely

Yes to some extent

Not when we needed it

Not needed

Didn't know this was available

Emotional support

Financial concerns or other practical problems

Sibling support

Youth and Transition

Please provide feedback for each of the bereavement support services you received from Helen & Douglas House. If not applicable, please tick the relevant box and leave the section blank.

A. One-to-one bereavement support: Please tick relevant boxes below. If not applicable leave blank.

	Exceptionally well	Exceptionally helpful	Very helpful	Slightly helpful	Indifferent	Not very helpful	Not helpful at all
How helpful was this in supporting you with expressing feelings and feeling understood?
How helpful was this in supporting you with understanding and accepting grief and loss?
How helpful was this in the strengthening of your social support and relationships?
How helpful was this in supporting you with managing and moving forwards with life?
How would you rate the accessibility and delivery of this support?