Charity Patient and Carer Panel Interest Form

Thank you for your interest in becoming a member of the Evelina London Children's Charity Patient and Carer Panel.

Support us Charity Patient and Carer Panel Charity Patient and Carer Panel Interest Form

Summary of opportunity

Information about the roles and what we are looking for can be found here.

Become a Charity Patient and Carer Panel member

If you would like to become a member, please complete our online expression of interest form below.

If you would like:

an informal conversation about the role(s)
support to help you apply for the role(s)
to submit your form without using email or the website
any other information

Please get in touch with elcc-patientcarerpanel@evelinacharity.org.uk.

What happens after you send your expression of interest?

Stage 1:

A staff panel will review your expression of interest together with the qualities and experience required for the relevant role (detailed under “Who are we looking for?” here).

The panel will include staff from Patient and Public Engagement Team from the Guy’s and St Thomas’ NHS Foundation Trust and Evelina London Children’s Charity. All successful expressions of interest will then go through to a second stage.

Stage 2:

You will be invited to an informal conversation with staff from Patient and Public Engagement Team from the Guy’s and St Thomas’ NHS Foundation Trust and members of Evelina London Children’s Charity.

In this conversation, you will be asked to talk more about your qualities and experiences. You can also ask any questions you may have about the role.

Stage 3:

We will contact you (within 14 working days of your informal conversation) to let you know the outcome.

Apply now

"*" indicates required fields

Step 1 of 3

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Your contact details

Title

Name*

First Last

Email*

Phone*

Address*

Address Line 1 Address Line 2 Town / City County Postcode Country

About you

Member type*

(Tick all that apply) Patient: if you have been a patient at Guy’s and St Thomas’, Evelina, Royal Brompton, or Harefield hospitals in the last 2-3 years. Carer: if you are a carer of a patient of one of the above hospitals.

Patient

Carer

Other (please specify below)

Other*

Gender*

Date of birth*

Please enter your date of birth. If you would prefer not to say, please enter '99/99/9999'

Preferred method of contact*

Tick all that apply

Phone

SMS

Post

How did you hear about this opportunity?*

Tick all that apply

Flyers

Poster in hospital waiting areas

Social media (Trust)

Social media (Charity)

GiST magazine

E-GiSt newsletter

Through a friend/colleague

Through a clinical/service staff member

Through a charity staff member

Prefer not to say

Other (please specify below)

Other*

Your experiences and interests*

Tick all that apply

Evelina London Children's Charity

Guy’s & St Thomas’s NHS Trust

Cardiology services

Community services

End of life care

Fair and equitable access to services

Inpatient services

Men's Health

Oncology services

Outpatient services

Research

Respiratory services

Surgery services

Transplant services

Urgent and emergency services

Use of technology in delivering health services

Other (please specify below)

Other*

Your qualities and experiences

Please explain why you want to join the Evelina London Children's Charity Patient and Carer Panel.*

Please give some examples of any qualities, interests, or experience that you feel might contribute to your role in the Evelina London Children's Charity Patient and Carer Panel.*

There will be an opportunity to nominate four people in the group to act as representatives of the wider Panel. The member representatives may be required to attend the Charity’s committee meetings and read papers for these meetings ahead of time.

Committee meetings take place on Microsoft Teams once every four months, and last approximatively 3 hours (including breaks).

As we are testing out how to work with the Panel, this frequency will be reviewed - although it would not be more frequent than this.

Additional information

The information you provide in this section will help us monitor our recruitment processes to ensure they are fair and allow us to attract diverse candidates. Your response is voluntary, and you can select “prefer not to say” if you would rather not answer any question. The information you provide will not be used as part of the selection process.

What do you consider to be your ethnic background?*

Please specify your ethnic background*

Do you have any of the following physical or mental health conditions or disabilities?*

Please specify other health condition(s)

Privacy Policy

Evelina London Children’s Charity is committed to protecting the privacy and security of your personal data. In this privacy notice we explain how we process personal data about you following your expression of interest for the Patient and Carer Panel. We also explain where you can find out more about your rights regarding the personal data that we hold about you, including how you can access, correct, and request erasure of your personal data.

Please refer to the this page where we outline how we use your data and how we keep it safe.

Who we are:

Evelina London Children’s Charity is a charity of Guy’s & St Thomas’ Foundation. The Charity will collect and store your data, which we may share with authorised staff at Guy’s and St Thomas’ NHS Foundation Trust who are supporting this work. The Foundation’s details are below:

Registered Charity No: 1160316

Company No: 9341980

Registered office address: The Grain House, 46 Loman Street, SE1 0EH

Collection of personal data and equality monitoring

For the purposes of this privacy notice, personal data means any information about an identifiable individual. It excludes anonymous data that is not associated with a particular individual.

We may collect and process the following categories of personal data to recruit for the Patient and Carer Panel:

Personal contact details such as name, title, addresses, telephone numbers, and personal email addresses
Date of birth
Other personal details in your response to the expression of interest form or that you otherwise voluntarily provide to us.

We do this on the basis of our legitimate interests in recruiting for the panel.

We collect and process special categories of personal data, if you choose to provide them. Collecting this data helps us understand if we are reaching people across diverse communities.

We rely on your consent to process these categories of personal data. You are not required to provide this information.

Where we have a legitimate need to process special categories of personal data for purposes not identified above, we will only do so after providing you with notice and, if required by law, obtaining your prior, express consent.

You may have a legal right to withdraw your consent under certain circumstances. To withdraw your consent, contact us at info@gsttfoundation.org.uk or using the contact information below.

We do this on the basis of our legitimate interests in recruiting for the panel.

Data retention

We will only retain your personal data for as long as necessary to fulfil the purposes we collected it for, as required to satisfy any legal, accounting, or reporting obligations, or as necessary to resolve disputes. We will retain personal data for up to seven years after recruitment or your term on the Patient and Care Panel ends, whichever is later. Under some circumstances we may anonymise your personal data so that it can no longer be associated with you. We reserve the right to use such anonymous and de-identified data for any legitimate purpose without further notice to you or your consent.

Rights of Access, Correction, Erasure, and Objection

Please keep us informed if your personal data changes. You may have the right to request access to, correct, and erase the personal data that we hold about you, or object to the processing of your personal data under certain circumstances. You may also have the right to request that we transfer your personal data to another party. If you want to review, verify, correct, or request erasure of your personal data, object to the processing of your personal data, or request that we transfer a copy of your personal data to another party, please contact us using the link below. Further information about your rights can be found at www.ico.org.uk.

More information

If you have any questions about our processing of personal data or to exercise your rights, please get in touch.

You can also find out more information here.