I was delighted and a bit nervous to be asked to chair a plenary session of the Australia Pacific Conference on Integrated Care. I was asked because I’m a Consumer Member on the Steering Committee for the Victorian Integrated Care Model, which is a project trying to improve the integration of care between when patients are in hospital and then return home with care through their local doctor or GP. ‘Value based’ care, ‘integrated care’, ‘consumer and community engagement’, continuous improvement of health outcomes and health care were key themes of the conference, which attracted a diverse audience from Asia, Australia, New Zealand and the Pacific. The people I met including doctors, nurses, managers, physios were all keen to hear what health care consumers like me and the Experience Expert panel had to say! Let me tell you that isn’t always the case, so we made the most of it! The Plenary was called Empowering and Engaging People and Communities and our session (note the consumer representative ownership) started with two great speakers. Danny Vadasz, CEO of the Health Issues Centre gave a presentation on ‘Supporting consumer engagement in the continuous improvement of health and care’ (the DRIVER model). Then, Dr Anthony Brown Executive Director of Health Consumers NSW presented on ‘Building a systematic consumer engagement program that underpins integrated care: A Consumer and Community Engagement Model for Health Services’. Both speakers talked about the difference between authentic relationships between health professionals or health services and consumers or patients to design, evaluate, improve and develop care and the more common experience for consumer advocates which may include being ignored, ‘educated’, manipulated, labelled or used as PR fodder. My fellow Expert Experience Panel members were Raj Liskaser, Sophy Athan, Stephanie Sandbrook and Phillip Nguyen. The Panel members talked eloquently about their experiences of health care including: having to re-state their personal information numerous times in one episode of care; being asked to repeat descriptions of their symptoms and their previous and current care; waiting; being ignored or misunderstood; having their drugs changed without their consent or knowledge; having to negotiate ‘the system’ alone; find follow up services; meet unexpected and unplanned appointments with specialists; submitting to duplicate tests within one health service; having to advocate and communicate on behalf of others such as confused, elderly people or those with limited literacy or English proficiency. When the Panel talked about times the health care system had worked well for them, they referred to individual practitioners who had ‘gone above and beyond’ to organise and coordinate their care. It seemed that it was common to be forever grateful for a health professional who took on the role of Navigator. One panel member was able to describe a particularly well organised multi-disciplinary program where the ‘patient or consumer’s care was mapped out and planned in consultation with the consumer. One audience member asked whether we thought we should be called Consumers, Patients or Citizens? This can become quite a complex theoretical issue which can also distract from the never talked about big element of the power differential between the person ‘being treated or cared for’ and the health professionals involved. I rather liked the title of citizen because when you need health and social care you are the same person as you are in the rest of your life, yet when we become the ‘receivers’ of care we have become conditioned to take a subordinate role. I believe this decreases the opportunity for great care by disempowering and silencing a key informant in the diagnostic, care and treatment process. It may also contribute to the high levels of isolation, stress and burnout among health professionals as they feel they must always be confident, never uncertain, never human. Yet these qualities are often exhorted by patients or consumers as the reason why they have benefited from the care of a health professional. Our current culture of care has encouraged poor communication, silos, inequality and power struggles. The Conference participants were desperate to do better in their health services and acknowledged many barriers to working with patients or consumers: including the way they were funded; their need for training or support to work differently; the frenetic pace of work in health care and uncertainty about their skills. They may well have thought I was a bit odd, but I urged them to return to their workplaces with commitment and the ‘chutzpa’ to start making a change in their area of care! As the song says From Little Things Big Things Grow