Wirral Carers Register Form

Online registration form for carers to register with WIRED.
A carer is anyone, including children and adults who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support. The care they give is unpaid. When we refer to carers in this document, this is inclusive of both adult and young carers.

WIRED is a Wirral based charitable organisation that was established in 2003. WIRED delivers a range of early intervention, prevention, well-being and financial related services through a blend of local authority grant funding and commercial income. Today we operate under the name Wired which stands for Wirral Information Resource for Equality and Diversity.

WIRED's core values are...
  • The promotion and development of a society in which disadvantaged people can lead full and independent lives fully participating in society and reaching their potential
  • To promote the equality, dignity and independence of disadvantaged children, young people and families and keep them safe from harm
  • To support children and young people to be ready for school, work and adulthood

WIRED cascades these core values into service delivery through a number of key organisational principals;

  • Empowerment – people should have control over their own lives
  • Consultation – involvement in service planning by disadvantaged people and carers
  • Information – clear and easily available
  • Participation – in local, regional and national communities
  • Autonomy– the freedom to make decisions about life
  • Person Centred – to ensure that all audit activity follows the journey of the client through our services
  • Outcome Based and Qualitative: – focussing on the how the service has improved people’s lives
  • Fair – equality and diversity issues are taken into account when developing and undertaking quality assurance activity
  • Transparent – to deliver clear messages about the purpose and benefits of service to encourage openness and willingness to participate
  • Ethical – always endeavour to respect participant’s privacy and confidentiality
  • Social value – wider financial and non-financial impacts of activity, including the wellbeing of individuals and communities, social capital and the environment
  • The above key organisational principals are embedded within service delivery through their integration into WIRED business planning, staff and volunteer recruitment, casework, staff supervision and organisational management and governance.

Our Services
  • Wirral Carers Health and Wellbeing Service
  • Wirral Health and Wellbeing Connectors
  • Wirral Mobility Scooter Hire and Shopmobility
  • Wirral SEND Partnership
  • Wirral Mediation Service
  • Wirral Direct Payment and Payroll Services
  • Wirral Personal Care Assistant Register

Please take a couple of minutes to complete the details.
Carer Information (Section A)

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* 1. Name

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* 2. Address and Postcode

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* 3. Telephone/Mobile

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* 4. Email

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* 5. Date of Birth

Date

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* 6. Gender

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* 7. Ethnicity

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* 8. Religion

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* 9. Sexual Orientation

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* 10. What is your current health status?

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* 11. Are you a smoker?

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* 12. Would you like a referral to the Smoking Cessation Service?

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* 13. Do you have a disability?

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* 14. If Yes to the above please state your disability

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* 15. Is your mental health or physical health likely to/being affected by your caring role?

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* 16. Do you live with the person you care for?

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* 17. How many hours do you spend caring per week?

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* 18. How long have you been providing care?

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* 19. What is your employment status?

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* 20. Housing tenure:

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* 21. Where did you hear about us?

About the person you care for (this information is used for monitoring and statistical purposes only)

Cared for Information

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* 22. Name of the cared for?

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* 23. Relationship to the Cared For:

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* 24. Date of birth of the cared for?

Date

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* 25. Gender

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* 26. Ethnicity

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* 27. Sexual orientation

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* 28. What is the condition of the person you care for? (please state)

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* 29. What primary support do you provide? (please state)

The following questions are about your GP practice

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* 30. GP Practice

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* 31. Are they aware that you are a carer?

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* 32. Would you like us to inform your GP of your caring role?

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* 33. Do you know that you are entitled to a free annual flu vaccination?

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* 34. Have you had an annual flu vaccination?

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* 35. Have you had a carer assessment?

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* 36. If yes, what was the outcome?

Section B

Please find below a Wellbeing Scale. It is essential we compile a detailed analysis highlighting the positive effect this Health and Wellbeing service is having on carers. This report is vital for the future continuation of our service and continuation of help and support for Carers on Wirral.

Below are some statements about feelings and thoughts. Please circle the number that best describes your experience of each over the last 2 weeks.

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* 37. Please select the answer that best describes your experience of each over the last 2 weeks

  Non of the time Rarely Some of the time Often All of the time
I've been feeling optimistic about the future
I've been feeling useful
I've been feeling relaxed
I've been dealing with problems well
I've been thinking clearly
I've been feeling close to other people
I've been able to make my mind up about things
Why this information is important...
  • The aim is to enhance support for people who have caring responsibilities and to ensure information and support is directed to you.
  • The register may be used to consult carers when planning services.
  • Occasionally information held on the database will be used to produce local and national statistics on carers; no personal details will be disclosed.
Wired (a Wirral voluntary organisation working with and for disabled people and carers) are working in partnership with the Wirral Health & Care Commission. Wired will hold, process and retain your personal data in accordance with our privacy policy and in compliance with the General Data Protection Regulations 2016 implemented 25th May 2018 and Wired’s Confidentiality, Data Management and Information Sharing Policies

As you have registered with this WIRED service WIRED will on occasion contact you via text message, email or telephone to provide you with information about other services provided by WIRED or other relevant organisations. WIRED will share the data collected in this form with Wirral Council, Public Health and your GP for the purpose of registering you as a carer with WIRED, registering you as a carer with your GP and maintaining a total count of known carers in Wirral Local Authority area. Please sign below to provide your consent to register you as a carer with WIRED and to share the data in this form with your GP, Public Health and Wirral Council.

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* 38. Carers Signature (typed full name)

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* 39. Date

Date

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* 40. Would you like a member of the Carers Team to contact you about any of our services? (please feel free to click multiple if you wish)

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* 41. Would you like to access befriending/wellbeing calls from the team (when available)

Thank you for completing the carers registration.

If you would like any more information, advice or support please contact us on 0151 670 0777 or cws@wired.me.uk.

We are open Monday to Friday, 9am-4:30pm.

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