ALL ABOARD!

Sign onto the Health Consumer Register

Tena koe, Kia Orana, Talofa Lava, Halo Oloketa, Ni Sa Bula Vinaka, Malo e Lelei, Fakaalofa Lahi Atu, Taloha Ni, Ko na Mauri, Ni hao, Namaste, Ohayou gozaimasu, Ahn nyeong ha se yo, Hello and welcome.

We greet you in many different languages, as people who use health and disability services come from all different cultures, ethnicities and communities within Aotearoa, New Zealand. We invite you to become involved in the work the Commission is doing to make sure health and disability services meet your needs and are safe.

There are a number of ways you may be involved - as a consumer, a consumer representative, a family/whānau/aiga member or as a carer. The Commission has different names for consumers to help us understand which role might suit people and what is required.

An experience based consumer is someone who is having or had health or disability care.

A representative advisor/consumer is someone who is having or had health or disability care AND belongs to a health or disability group.

A carer is someone who helps a consumer but doesn’t get paid.

Family/whānau/aiga are people who the consumer wants to be involved in their care.

Questions and answers

How will the information I giveyou be used?

We will use what you tell us to make up a Health Consumer Register for our staff to look at when they need to involve consumers, family/whānau/aiga or carers in the work of the Commission. We also get requests from other health and disability providers for consumers to get involved in their work. If this happens, we will ask for your permission before givingyour details to anyone else.

If I go on the Health Consumer Register will I get a role on a board, committee or as part of a project?

Putting your name on the Health Consumer Register does not mean you will automatically be involved. We need consumers, family/whānau/aiga or carers for many different reasons. It could be for regular meetings and at other times it may be a one-off meeting or a phone call to get advice. Sometimes we need people with specific health and disability issues, like diabetes, and at other times we might need advice from people within a certain age range,or particular ethnic and cultural background, etc. Having your name on the Health Consumer Register will be a good start to being involved and help us to contact you in case you are available and want to participate in the Commission’s work.

Will I be paid for my time if I am asked to be part of a group or committee?

It depends on how much is involved. The Commission believes that the experience of being a health or disability consumer, family/whānau/aiga, or carer is important, and should be valued. The Commission has a policy to pay all people who participate in our work programmes unless you are already paid and working with the Commission counts as part of your employment. If you are selected and agree to participate the Manager of the programme you are working on will give you more information about this.

What sort of work is involved?

Depending on your skills and experience we may ask you to be part of an Expert Advisory Group, or on a committee. Other roles include sharing your experiences within health and disability services in writing or on video.

Personal details (fill in as much as you want to)

1.Name:

2.Address:

3.Phone numbers:

4.Email:

5.GenderFemaleMale

6. Which ethnic group do you belong to? Mark the space(s) that apply to you.

NZ European / Niuean
Māori / Chinese
Samoan / Indian
Cook Island Māori / Other (such as Dutch, Japanese, Tokelauan) Please state
Tongan

7.Tell us what level of involvement is of interest to you – tick as many as you like:

Governance (being on a Committee where decisions are made)

Policy (being invited to contribute to new policies about Commission work)

Experience based (sharing my personal experiences about health and disability services through story, writing, video, pictures etc.)

Being part of a hui/focus group

Anything else?

8.What role best suits your skills and experience

Experience based consumerRepresentative/advisor consumer

CarerFamily/whānau/aiga

For more information about these different names see:

9.Please tell us about your skills and experience that relate to your involvement in the
health and disability sector:(use extra paper or send us your cv if you want to)

10.Have you experienced any of the following?

a fall while in a care settingan infection from hospital

a mistake with medicationproblems from having surgery

unexpected death of family/whānau/aiga member

11.Is there anything else you think we should know?

If you want to know more about the Commission work or this database please contact Chris Walsh(04) 901 6048 or Linda Gilbert (04) 901 6049 at the Commission.When you have finished this form please email it to: you can post it to the:Consumer Engagement Team, Health Quality & Safety Commission, PO Box 25496, Wellington.