1. In any patient pathway the first visit to a health care professional is the start of the pathway for the health care professional but it is not the first step for the patient. There might have been multiple call outs to ambulance services without any action and there might be significant barriers to obtaining care due to budgetary or family constraints. When we start to co-design a pathway with a consumer we start right at the beginning and record the journey from their first experience. What this has shown on almost all pathways is that health promotion campaigns fall short of empowering people to take action about their health and that there are all sorts of barriers to entry into health care which need to be addressed. 2. When consumers enter the system they are the best people to identify barriers in every part of the journey within primary, secondary and tertiary health care. For example, assumptions by health care professionals, such as the provision of community support or the supply of equipment are systems that are working well are completely debunked and exposed as non-existent by consumers. Collaborative clinical pathway design can lead to a complete system redesign. 3. The inclusion of accessible health information, especially in the form of video and photos, which consumers have agreed are helpful, is included in all pathways and what has become very clear is that a lot of information is written for health care professionals but given to consumers.