Feedback Capture SE Talent and Leadership Network NameE-mail AddressPlease state what NHS Region you are from* East of England London North East and Yorkshire North West South East South West Midlands I do not know Other If you selected Other for NHS Region, please specify:*Please state your job role:*Would you describe your role as:* Clinical – I provide clinical care Non-clinical – I do not provide any clinical care Do not wish to disclose What is your occupational group?*Additional Clinical ServicesAdditional Professional Scientific & TechnicalAdministrative & ClericalAllied Health Professionals/ Healthcare Scientists/ Scientific and TechnicalAmbulance (operational)Commissioning (manager/ support staff)Estates & AncillaryGeneral Management – if you are a manager and can choose from elsewhere in the list please select the other group)Healthcare ScientistsMedical & DentalMidwiferyNursingNursing or Healthcare Assistants (Nursing Auxillary/ Nursing Assistant/ Healthcare Assistant)Patient and Citizen LeaderPublic Health/Health ImprovementSocial CareStudentWider Healthcare TeamOtherIf you selected Other for occupational group, please specify:*Do you work or is your primary role in the following area of care:*Primary CareSecondary careVoluntary, community and social enterprise (VCSE) sector careSocial CareLocal GovernmentI do not wish to discloseUnknownOtherIf you selected Other for your primary role, please specify:*Do you have face-to-face contact with patients / service users are part of your day job?* Yes, frequently Yes, occasionally No For NHS and Social Care staff – please select your Agenda for change band*Band 1 – E.g. domestic support worker, housekeeping assistant, driver and nursery assistant.Band 2 – E.g. domestic support worker, housekeeping assistant, driver, nursery assistant, domestic team leader, security officer, secretary/typist and healthcare assistant.Band 3 – E.g. emergency care assistant, clinical coding officer, estates officer and occupational therapy worker.Band 4 – E.g. assistant practitioner, audio visual technician, pharmacy technician, dental nurse and theatre support worker.Band 5 – E.g. (includes many newly qualified clinical professionals) – operating department practitioner (ODP), podiatrist, learning disability nurse, therapeutic radiographer, practice manager and ICT test analystBand 6 – E.g. school nurse, experienced paramedic, health records officer, clinical psychology trainee and biomedical scientist.Band 7 – E.g. communications manager, estates manager, high intensity therapist and advanced speech and language therapist.Band 8a – E.g. consultant prosthetist/orthotist, dental laboratory manager, project and programme management, modern matron (nursing) and nurse consultant (mental health nursing).Band 8b – E.g. strategic management, head of education and training, clinical physiology service manager and head orthoptist.Band 8c – E.g. head of human resources, consultant clinical scientist (molecular genetics/cytogenetics) and consultant paramedic.Band 8d – E.g. consultant psychologist (8c-8d), estates manager, chief nurse and chief finance manager.Band 9 – E.g. podiatric consultant (surgery), chief finance manager and director of estates and facilities.VSMMedical/Clinical: E.g. Consultant, Doctor, Dentist, General Practitioner, Trainee Doctor, Academic DoctorApprenticeOtherI do not wish to discloseUnknownIf you selected other for Agenda for Change band, please specify:*For non-NHS – please specify your organisation/career grading i.e. Administration/clerical, Management, Senior management, Board member, or Other/ Do not wish to disclose*Organisation*Ashford and St Peter’s Hospitals NHS Foundation TrustAylesbury Vale District CouncilBerkshire Healthcare NHS Foundation TrustBerkshire Primary Care LtdBerkshire West ICBBerkshire West Training HubBracknell Forest County CouncilBrighton and Hove ICBBrighton and Hove City CouncilBrighton and Hove Training HubBuckinghamshire ICBBuckinghamshire County CouncilBuckinghamshire Healthcare NHS TrustBuckinghamshire Training HubCentral Surrey HealthCentral Sussex and East Surrey Commissioning AllianceCherwell District CouncilChiltern District CouncilCoastal Training HubDartford and Gravesham NHS TrustEast Berkshire Primary CareEast Kent Hospitals University NHS FTEast Kent Training HubEast Sussex ICBEast Sussex County CouncilEast Sussex Healthcare NHS TrustEast Sussex Training HubEpsom and St Helier NHS Foundation TrustFirst Community Health and CareFrimley ICBFrimley Health NHS Foundation TrustFrimley ICS Training hubHampshire County CouncilHampshire Hospitals NHS Foundation TrustHampshire, Southampton and Isle of Wight ICBHart District CouncilHart Voluntary ActionHealth Education England – South EastHealth Education England – Other RegionHealthwatch BuckinghamshireHealthwatch OxfordshireHealthwatch ReadingHealthwatch West BerkshireHealthwatch WokinghamIsle of Wight CouncilIsle of Wight NHS TrustKent and Medway ICBKent and Medway HealthwatchKent and Medway NHS and Social Care Partnership TrustKent Community Health NHS FTKent County CouncilKent Local Medical CommitteeMaidstone and Tunbridge Wells NHS TrustMedway Community Health CareMedway CouncilMedway NHS FTMid Wessex Training HubNHS EnglandNHS Wessex Clinical Senate and NetworksNHSXNorth Kent Training HubOxford Academic Science NetworkOxford City CouncilOxford County CouncilOxford Health NHS Foundation TrustOxford University Hospitals NHS Foundation TrustOxfordshire ICBOxfordshire Training HubPortsmouth and IoW Training HubPortsmouth ICBPortsmouth City CouncilPortsmouth Hospitals University NHS TrustQueen Victoria Hospital NHS Foundation TrustReading Borough CouncilRoyal Berkshire NHS Foundation TrustRoyal Borough of Windsor and MaidenheadRoyal Surrey NHS Foundation TrustRushmoor Borough CouncilRushmoor Voluntary ServicesSalus Medical Services LtdSlough Borough CouncilSlough CVSSolent NHS TrustSouth Bucks District CouncilSouth Central Ambulance Service NHS Foundation TrustSouth Central and West CSUSouth East Coast Ambulance Service NHS Foundation TrustSouth Oxfordshire District CouncilSouthampton and New Forest Training HubSouthampton City CouncilSouthern Health NHS FTSurrey and Borders Partnership NHS FTSurrey and Sussex Healthcare NHS FTSurrey County CouncilSurrey Heartlands ICBSurrey Heath Borough CouncilSurrey Heath Community providersSurrey Training HubSussex CommisionersSussex Community NHS Foundation TrustSussex Partnership NHS Foundation TrustThe Federation of Windsor, Ascot and Maidenhead PracticesUniversity Hospital Southampton NHS Foundation TrustUniversity Hospitals Sussex NHS Foundation TrustVale of White Horse District CouncilVirgin CareVoluntary Action South West SurreyWaverley Borough CouncilWessex Academic Health Science NetworkWessex Local Medical CommitteesWest Berkshire CouncilWest Kent Education NetworkWest Kent Primary CareWest Oxfordshire District CouncilWest Sussex ICBWest Sussex County CouncilWokingham Borough CouncilWycombe District CouncilOtherIf you selected other for Organisation, please specify:*Please select the ICS your organisation is in*Buckinghamshire, Oxfordshire and Berkshire West ICSFrimley Health and Care ICSHampshire and Isle of Wight ICSKent and Medway ICSSurrey Heartlands Health and Care PartnershipSussex Health and Care ICSI do not knowOtherIf you selected other for ICS, please specify:*On a scale of 1-5 how useful did you find the networking session 1- not useful 2 3 4 5-very useful What did you enjoy / find most useful about the network session?What would you like from the future network sessions?Please share any other comments to inform the SE Talent and Leadership network going forwardIf you would like to share your work at a future session please let us know – topic, how long, anything elseEquality Diversity and InclusionAlthough we will be able to see your name and email address upon submission, once extrapolated this data will be anonymised. We appreciate your support in providing this information, which will help us to ensure our leadership development interventions are widely accessible and inclusive.Please indicate your age range below:Under 2020 – 2930 – 3940 – 4950 – 5960 +I do not wish to disclosePlease describe your gender below:MaleFemaleNon – binaryUnknownDo not wish to discloseAnother gender (please complete the box below)I prefer to self-describe:Is your gender identity the same as the one you were assigned at birth? Yes No I would describe my ethnic origin as:White – BritishWhite – IrishWhite – Any other White backgroundMixed – White & Black CaribbeanMixed – White & Black AfricanMixed – White and AsianMixed – Any other Mixed backgroundAsian or Asian British – IndianAsian or Asian British – PakistaniAsian or Asian British – BangladeshiAsian or Asian British – Any other Asian backgroundBlack or Black British – CaribbeanBlack or Black British – AfricanBlack or Black British – Any other Black backgroundAny other ethnic groupOther ethnic group – ChineseUnknownDo not wish to discloseOther ethnic group (please specify):If your ethnic group is not included in the above, please specify below:Please select the option which best describes your sexuality; Please tick as appropriate:AsexualBisexualGay or LesbianHeterosexualOtherDo not wish to discloseUnknownPlease indicate your religion or belief; Please tick as appropriate:AtheistBuddhistChristianHinduJain DharmaJewishMuslimSikhI do not hold a religion or beliefI do not wish to disclose my region/beliefOther (please specify):If you selected ‘Other’ for your religion or belief, please specify:Do you consider yourself to have a disability? Please tick as appropriate: Yes No If you answered Yes, please state the type / types of impairment which applies to you, if you are disabled but none of the listed categories apply, please mark Other. Learning Difficulty/ Condition Long-standing Condition Mental Health Condition Physical Impairment Sensory Impairment I do not wish to disclose this information Other If you selected ‘Other’ to the type of impairment, please specify: