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The Mid Yorkshire Hospitals NHS Trust NHS North Kirklees Clinical Commissioning Group NHS Wakefield Clinical Commissioning Group

Our health is changing. A lot of the illnesses we once knew are a thing of the past. The treatments we receive when we’re ill are often light years ahead of what we are used to. And the NHS is changing too. Maybe you want to know more about what the changes might mean? Or maybe you would like to share your views on the way change happens? Or maybe you want to let us know about your experience? It’s your health, and we want you to hear what you have to say. How can you share your views? We have set up a network for local people who care about the NHS to help us in the shaping of health services the ‘your health, your say’ network. What does ‘your health your say’ involve? We will send you regular information about the changes that are happening across the Mid Yorkshire area – that’s North Kirklees and the Wakefield District. You might also be asked to: • take part in discussion groups and conversations • attend public consultation events • fill in questionnaires. You can choose how much or how little you get involved. How can you add your name to the ‘your health your say’ network? If you would like to find out more about how you could get involved or if you would just like to receive more information about your local NHS services, please fill in the attached form.

About us Across the country groups of doctors and other clinicians are taking responsibility for ‘commissioning’ most local NHS services. That means planning and paying for them. In North Kirklees the NHS North Kirklees Clinical Commissioning Group (CCG) is taking on this responsibility. In Wakefield District it is the NHS Wakefield Clinical Commissioning Group (CCG). Most patients who need hospital care in this area will be treated by The Mid Yorkshire Hospitals NHS Trust. There are three vibrant local hospitals in Dewsbury, Wakefield (Pinderfields) and Pontefract. Together the CCGs and the hospitals are determined to provide services that give the best possible health results for local patients. And that’s why we hope you will want to get involved. Your health, your say However you choose to be involved in the your health your say network, you will be helping to shape local NHS services, for now and for future generations. Don’t forget to fill in the attached form if you would like more information. Thank you

Sign up to Name: Address:

Postcode: Email address: Telephone:

Which area do you live in? North Kirklees

Wakefield District

Other, please specify

How would you like us to contact you? Email


We would like to know what health issues you are most interested in, or would like to know more about. Please tell us below:

Your information The information you have provided will be kept strictly confidential by the local NHS in North Kirklees and Wakefield District in accordance with the Data Protection Act. Your personal information will not be shared with any other agencies.


The information will help us contact you on local health matters of most interest to you. The results we obtain from surveys will not disclose any individual information or views. If at any time you wish to leave the network please contact us and we will ensure your details are completely removed from your health, your say.

Form continues over the page‌

Monitoring information (optional) We would like to make sure that is representative of the communities we serve and sometimes may want to seek views from specific groups. You can help us to do this if you fill in this section.

What gender are you? Female


Prefer not to say

Under 16

16 - 25

26 - 35

36 - 45

46 – 55

56 - 65

66 – 75

76 - 85

86 +

What is your age?

What is your ethnic background?

Asian, or Asian British

Black, or Black British






White & Asian


White & Black African White & Black Caribbean

Kashmiri Pakistani


British European Gypsy/ Traveller Irish

Prefer not to say

Other (please state)

Do you consider yourself to have a disability? Yes


Prefer not to say

Do you provide care for someone? Yes


Please return this form to: or email us on or phone us on 01924 317651

Engagement Shared Service, NHS Calderdale, Kirklees and Wakefield District, FREEPOST RSHB-GRJU-ALSL, Broad Lea House, Dyson Wood Way, Huddersfield, HD2 1GZ


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