* 1. Firstly please can you tell us abit about yourself.

a) Are you :

* b) Do you work or volunteer for a health-related organisation (e.g. NHS, Healthwatch etc.) or charity (Macmillan, Marie Curie, Cancer Research UK, etc.)?

* c) Are you?

* 3. Following the review of the service, we are proposing two possible options for the future of inpatient haematology services in Stafford and Cannock.

i) To do nothing
ii) To move these services from County Hospital to Royal Stoke University Hospital and New Cross Hospital in Wolverhampton on the grounds of patient safety and service sustainability.

Are there any other options you think we should consider?

* 4. As set out in Section 7 of the Public Consultation document, the CCG has assessed the proposal to move inpatient haematology services to the Royal Stoke and New Cross Hospitals against the TSA criteria. Do you feel that these criteria have been applied fairly?

* 5. Please add any further comments in the space below.