It has been a year since Bill 10, the latest health and social services reform came into effect, and as anyone who has had contact with our institutions knows, you do not want to get sick.

For sure, those in acute conditions are being cared for, but if it’s a senior, for example, she may need ‘round the clock’ care from a private nurse or nurse’s aide to get the full attention she deserves.

We have seen, with the tragic case of filmmaker Mark Blandford last fall, that government ordered cutbacks are trickling down to affect life and death decisions. In his case, the doctor, who was ready to perform surgery at St. Mary’s, was ordered not to by a senior bureaucrat then in charge of West Island integrated health and social services.

Blandford was instead shipped by ambulance to the distant MUHC hospital where he died before another doctor could intervene to possibly keep him alive. It’s thanks to confidential information on the case leaked to The Gazette’s Aaron Derfel and follow-up from staff, on the condition of anonymity, that the case came to light. The Quebec coroner’s office is looking into the case.

With the burgeoning cost of maintaining healthcare for an aging population, which this year amounts to 38 per cent of government spending, the legislation that came into effect last year consolidated bureaucracies into integrated health and social service centres – centres intégrés in French – with five on the island of Montreal. As lawyer Eric Maldoff pointed out in a recent interview, the president and CEO of each of these centres intégrés reports directly to the deputy minister in Quebec. They are under direct political control from the centre and risk losing their job if they speak out.

This is not some remote technical point, but rather indicative of a new level of control from the centre that supersedes the former situation, where a hospital or other healthcare or social service agency had its own director general, who responded to a board of directors. What was once your neighbourhood or favoured family hospital no longer has a board of directors. These institutions no longer respond to a board that represents the public, keeping their management on their toes.

Locally based institutions are no longer quasi-autonomous, but part of the broader public administration. Under new legislation now under consideration, even members of not-for-profit organizations may have to register as lobbyists in order to try to influence the government. This could further distance those who control our health and social service institutions from public scrutiny and accountability.

This situation calls on the public to get more involved and act as watchdogs. The public is authorized, under amendments lobbied for by the Quebec Community Groups Network, to serve on advisory committees that the new law mandates for all recognized bilingual institutions. The committees are expected to act in the community interest, to ensure the social, cultural, and linguistic needs of users are protected. These advisory bodies need people who are connected with the public, understand the system, and how government works.

We urge all those who have the time, the desire to keep our system working as smoothly and efficiently as possible, and the ability to study and understand its complexities to get involved in these advisory bodies. It could be as important in maintaining the quality of healthcare service as hands-on volunteering in a ward or day-surgery waiting area.

When we see things go wrong, we must react. Some of the ways this can happen is in contacting the media, calling our political representatives, organizing and joining others in public interest groups and protesting. This is the new reality.

Offering to serve on these advisory committees is one of many ways to volunteer. As Roula Dafniotis, who is profiled in this issue, has shown, you don’t have to be an expert to help make our hard-pressed institutions function better.

The experience and judgment we seniors have can go a long way in helping ensure that our bilingual healthcare and social agencies and English public schools retain their quality at a time when austerity threatens to overrule the public-service standards and values of caring and sharing that most of us believe in.