On the 20th of November 2024, 85% of public hospital workers went on strike. They are complaining about net wages of 3 Euros an hour for junior doctors, 12-hour shifts, endless waiting lists for patients and gross underfunding of the public healthcare system. As a result, young doctors and nurses are going abroad and people in Italy are unable to get appointments with specialists. Those who can afford it are turning to the private healthcare system. With friends from Labournet.tv we subtitled <a href="https://en.labournet.tv/general-strike-hospital-workers-italiy">this short film</a>.
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Film – General strike of health workers in Italy, November 2024

We translated the introduction and a health sector-related article from a French Canadian magazine, published by public sector workers. In the near future we will translate further texts on sit-in actions by nurses in Canada, spreading the word amongst the wards &#8211; watch this space!
La Grande démission [0] is a self-organised workplace initiative in the public sector in Canada. It brings together workers from the health and social services, education and civil service networks who meet regularly to reflect and propose analyses, demands and strategies which aim at class unity. Our understanding of the issues is based first and foremost on our own experiences and those of our colleagues with whom we discuss informally or through more structured interviews.
Our approach wants to lay the foundations for a community of struggle among public service employees, based on active solidarity among colleagues in all job categories, but also with the working and popular classes in this country and beyond.
From a managerial point of view, the ‘great resignation’ represents employers&#8217; fear of a generation of workers that no longer accepts any kind of working conditions or doing anything no matter what. For us, it embodies the rejection of work as it is, whether this resistance takes the form of a strike, a slowdown or mass resignation, a formidable weapon that must be reclaimed and organised collectively. While employers and the government see the labour shortage in many sectors as a reason to work harder, we see it as an opportunity to seize the upper hand.
Public sector collective contract negotiations are an opportunity for us to participate in the debate on our living conditions and on the subversive potential of our positions in society, but we intend to organise well beyond the signing of collective agreements. Our initiative aims to help shift the balance of power in our favour in the conflict between us and the state as employer and the ruling classes, with a view to fundamentally transforming our lives and achieving a better life for all.
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Breaking down barriers &#8211; Divisions between job categories in the healthcare network 
by Félix Dumas-Lavoie, IT technician at an integrated health and social services centre
The situation on the ground within the health network is chaotic. With the Santé Québec reform, the government wants to make the healthcare system more efficient by starting changes at the top. The timing is almost perfect, in the worst possible sense: the reform is being implemented at the same time as budget cuts are being announced and imposed in the public sector.
Penny-pinching is the order of the day. Cuts are being made everywhere, whether by preventing overtime or imposing a hiring freeze. This is particularly ridiculous when you consider that it now costs almost twice as much to pay the senior managers of Santé Québec as it did when it was created. [1] The issue of overtime is becoming a thorny one for managers in times of cutbacks. As the watchword is spending reduction, we are seeing all kinds of sweeping measures to reduce overtime spending across the board.
In an IT technician environment, overtime is virtually prohibited [2] even though it may be necessary to perform important maintenance updates outside office hours. For a colleague working on the floor of a Montreal hospital, overtime has been reduced to a strict minimum in her workplace, even though she and her colleagues almost always work overtime to prevent work from piling up, which managers are well aware of.
Uneven resistance
Whether it&#8217;s Santé Québec or the rather predictable cuts, we have to understand that we can never rely on the union machine and bureaucracy to defend our gains in the face of their reforms. The last few months are no exception. With the announcement of Bill 89, which would grant essential status (and thereby impose a minimum service) to just about every job category the government wants, it is the right to strike itself that is under attack.
If what has happened over the past year is anything to go by, then it seems likely that the resistance will not be up to the task. The end of last fall&#8217;s public sector negotiations, led by the nurses behind the FIQ [3], was marked by the fight against mandatory overtime (TSO), but also against the arbitrary transfer of workers from one workplace to another. One of the issues on which the FIQ and the government negotiated was the maximum number of kilometres that workers could be transferred between two workplaces. If the nurses made some gains with this strike, it was also because they rejected the agreements and pushed the struggle further than the ‘Common Front’ (The Common Front is an alliance of public sector trade unions). [4]
At the CSN [5], in response to the latest existential crisis following a particularly disappointing Common Front for low-wage earners, a new campaign was launched. Its name is ‘Vraiment public’ (Truely Public). Among other measures, and without much original thinking, the organisation is calling for an end to budget cuts and the use of health agencies within the network [6], which is somewhat ironic given that the workers who left the public sector jobs to join agencies had very good reasons for doing so. [7]
True solidarity
There is no need to look very far to find complex points in common with distant colleagues: we share different forms of refusal to work. Because work in the health network is not only built on monstrous inconsistencies, it is based on certain common managerial principles and a hierarchical vision that everyone has to deal with. Reducing working hours (while maintaining the same salary) is a good common demand for workers on the shop floor and in administration. Everyone, especially on the shop floor, lacks time. This must be accompanied by an end to the hiring freeze, followed by concrete measures to make work on the shop floor decent on a daily basis &#8211; because it is all very well to hire people, but they still have to want to stay. This, combined with the demand for the same decent pay regardless of job category, would be a good way to build solidarity between different professions. No more low-paid categories. Once you enter the public sector, you have good conditions and arrangements are made to ensure that all colleagues are entitled to them. Because it is wrong to say that workers with professional status necessarily work harder than low-paid workers. Whether we like it or not, it all comes down to the balance of power between workers and the government, no matter how you look at it. If we want to have any chance of organising, workers must start talking to each other.
In practice, these ideas are in line with certain demands made by workers. During Covid, unionised CPE (educational) workers have been demanding a fair pay rise for all job titles. [8] Not only is there a disparity between CPEs and the rest of the public sector, but there is also a disparity between different areas of childcare, with professionals not being paid the same. Extending the demand for equal pay to the entire public sector would be a very good idea and could create a solidarity that we have hardly ever seen before. Taking demands beyond union accreditation, in inter-professional solidarity, is one of the ingredients missing for a possible victory.
To move beyond sectorialism
While a union will tend to be cautious legally and politically, workers can make a difference by organising resistance from the grassroots. However, creating solidarity between autonomous grassroots movements can be complicated.
In this regard, we can learn from the nurses. We must give these care workers what is theirs: the situation is obviously disastrous, and they have made several very courageous moves in recent years, without the backing of their union representatives. [9] Those with a certain political awareness can see that the healthcare workers are not a monolithic bloc, and a three-way tension can be detected between the employer, the FIQ and the workers themselves. This adversity can be exhausting and give the impression that workers in a sector are alone in their struggle. This highlights the importance of creating interprofessional solidarity on a permanent basis, beyond the immediate period of contract negotiations, which remain strong in the long term.
The obstacles to this solidarity are also reflected in the relationship between a given occupational group and the rest of the workforce. For example, it is easy as an administrative worker to fall into the sanctimonious public discourse of nurses, a discourse with Catholic roots about vocation (“nurses do the work, because they are caring people”). This essentialising discourse harms all caregivers because of what it presupposes. In particular, it feeds the isolation between these workers and others and contributes to union corporatism.
Of course, this is only one piece of the puzzle. Most recognised occupational groups tend towards corporatism. Everywhere, we must question the justification for sectorial politics. It is difficult to build bridges between colleagues on the shop floor and in administration when our respective union bureaucracies constantly pass the buck, saying that the others do not want to collaborate. Why, during every negotiation period, is it impossible to build a real common front with the FIQ and everyone else? In their own ways, the bureaucracies of the FIQ and the CSN are both responsible for the weak resistance we can muster against government reforms and measures. We still need to build sufficient strength to improve our conditions, something that has not been done for a very long time. The union movement reflects a fragmented and hierarchical health care system, but this is certainly not inevitable. Sectorial politics must be overcome if workers really want to regain control over their conditions. We must not wait for the union structures to do this job for us: it won&#8217;t happen. It is up to us to build this solidarity between different sectors of employment in our daily work and struggles.
The silos
The local healthcare system is a little more complex than a potato field. It is not just a vestige of our modern divine state; each neoliberal reform adds to the complexity of the landscape rather than simplifying it, which contrasts with the successive statements by state managers who say they are implementing these so-called health reforms to make the system more efficient. Often, archaic administrative procedures, which are difficult to monitor, coexist with more modern ones, which, far from freeing up our time, tend to make work even more intense without any real gain in efficiency for workers. In each CIUSSS [10] (they are still in existence for the moment), there are several thousand teams, sometimes tens of thousands of workers. Then, within this micro-society, there is a division between administration, the shop floor, operations, etc. These are all macro-teams that form sectors that do not talk to each other or avoid talking to each other as much as possible because of obvious differences that may arise over the years. I owe my colleague the term ‘silos’ to describe this situation. These silos are also present within the macro-teams, because there are so many sub-teams and hierarchies that it&#8217;s enough to make your head spin, like the 12 tasks of Asterix. Building bridges between colleagues, and not just within your immediate team, is undoubtedly the first task for anyone who dares to make even the slightest positive change in the autonomous organisation of health workers. It&#8217;s the elephant in the room when it comes to breaking down silos at the macroscopic level.
For an administrative worker in the health network like me, the current context is that of a society still marked by the passage of the COVID pandemic. Teleworking has become the norm. For colleagues, the advantage of teleworking is the time saved on commuting and the work-life balance. In my opinion, it would be more interesting to try reducing working hours without loss of pay than to compromise on full-time teleworking. At the macro-team level, we are rarely in our workplace, and even if everyone wanted to return to the office, savings have been made on our office space: these are mobile offices that have to be booked and there are not enough for everyone. Teleworking therefore clearly isolates us from other job categories and from meaningful contact with colleagues who are further away. Of course, it reflects a certain generalised refusal to work, but it is often defended as a privilege, even though many claim to be ‘more efficient’ when teleworking. In any case, teleworking does not seem to encourage interprofessional solidarity.
Twenty thousand miles under the wall
In his film Wings of Desire, Wim Wenders presents 1980s Berlin as an extremely divided city where each citizen constitutes their own mini-state, evolving in their own universe with their own language. The goal is to be able to talk to everyone, one person at a time. Admittedly, there is probably a good analogy to be made with trade unionism in the public sector today. In this case, the elephant in the room is that, among other things, the CSN and the FIQ do not want to work with each other and, according to the latest news, are likely to keep passing the buck on this issue indefinitely. This situation is unacceptable, but above all, it is a lie that feeds the defeatist fringe that often makes up the union bureaucracy. This undermines the prospects for workers&#8217; emancipation. While traditional unionism still has a role to play, solidarity between colleagues near and far is gradually being built in our workplaces by challenging the various boundaries imposed by current union structures. Nevertheless, for public sector workers who choose to take an independent approach to trade unions, the challenge at this stage is also one of communication. We need to find each other so that we don&#8217;t exhaust ourselves in vain. It takes people from different backgrounds to build a strong movement, but also to fuel the debate. This can be done by putting forward unifying demands in the workplace, at general assemblies and, in the event of a strike, on the picket lines. Trade unionism is no exception to the general movement of the masses in our time, as the trade union machine has its own interests that clash with those of progressive workers and even the vast majority of workers. Ultimately, it is clear that trade union structures still help the cause of workers; they do so despite themselves. It remains necessary to build bridges of critical solidarity, whether or not they pass through them, between colleagues who refuse to work as things currently stand. This is particularly important in a project that aims to regain control over our individual and collective condition in the face of the labyrinthine machine that is the health and social services network, which will destroy us all if we let it.
Footnotes
[0] 
The Great Resignation, also known as the Big Quit was a mainly American economic trend in which workers voluntarily resigned from their jobs en masse, beginning in early 2021 during the COVID-19 pandemic. Among the most cited reasons for resigning included wage stagnation amid rising cost of living, limited opportunities for career advancement, hostile work environments, lack of benefits, inflexible remote-work policies, and long-lasting job dissatisfaction.
[1] 
« Près de deux fois plus cher pour payer les hauts dirigeants », La Presse, 2nd of April 2025.
[2] 
Here, we are referring to regular overtime paid at one and a half times the normal rate. It is also possible to work overtime in order to accumulate time in a bank and then rearrange one&#8217;s schedule (take time off in lieu), but in this case, it is paid at the normal rate and tends to be limited.
[3] 
The Fédération interprofessionnelle de la santé du Québec–FIQ is a labour organization founded in 1987 that today has over 80 000 nursing members who work in health institutions all across Quebec.
[4]
<blockquote class="wp-embedded-content" data-secret="tcwF7BAx0l"><a href="https://www.frontcommun.org/les-organisations/">Les organisations du Front commun</a></blockquote>
<iframe loading="lazy" class="wp-embedded-content" sandbox="allow-scripts" security="restricted" style="position: absolute; visibility: hidden;" title="&laquo; Les organisations du Front commun &raquo; &#8212; Front commun" src="https://www.frontcommun.org/les-organisations/embed/#?secret=TKeLeS4Q1A#?secret=tcwF7BAx0l" data-secret="tcwF7BAx0l" width="500" height="282" frameborder="0" marginwidth="0" marginheight="0" scrolling="no"></iframe>
[5] 
The Canadian Society of Nephrology is a society of physicians, scientists, and professionals specializing in the care of people with kidney disease and in kidney research.
[6] 
‘Bill 10: ‘Private employment agencies must stop cannibalising the public network’, CSN, 14th of March 2023.
[7] 
On this subject, see the article ‘The return of those who resigned’ in this newspaper.
[8] 
“CPE: Government offers crumbs to curb labour shortage”, 13th of July 2021
[9] 
One might think here of the continuation of last year&#8217;s strike, the sit-ins, the waves and threats of resignation, and the many other examples of insubordination that we hear about.
[10] 
Centres intégrés universitaires de santé et de services sociaux (CIUSSS), ‘Integrated university health and social services centres’

‘La Grande démission’ – The Great Resignation in Canada

In May and June 2025 around 600 to 700 workers employed by Charité Facility Management (CFM) went on strike for equal pay. The CFM is a subsidiary of the public hospital Charite.The company employs a total of 3,000 workers as hospital porters, cleaners, kitchen and canteen, sterilisation and maintenance workers. The CFM workers have a separate collective agreement, which allows management to pay them up to 20% less than the other hospital workers who are part of the public sector collective contract. There has been a long struggle by CFM workers against this division &#8211; both left parties and the trade union Ver.di, played a problematic role.
Years of betrayal
In 2006, the federal state government of Berlin of the SPD (Social Democratic Party, &#8216;Labour Party&#8217;) and PDS (today ‘Die Linke’, &#8216;The Left Party&#8217;, ‘socialists’) decided to outsource CFM in order to save money &#8211; the public hospital Charite, and thereby the state government, still owns 51% of CFM and has therefore maintained its influence over the dispute over outsourcing. 
In 2011, during the public sector strike led by Ver.di, the trade union decided to call off and settle a strike of 10,000 Charite university hospital workers who were employed on public sector contracts. This left the strike of the CFM workers, which was also led by Ver.di, in an isolated situation. Since then the CFM workers not only had lower basic pay, they were also excluded from various extra payments (holiday, shift premiums etc.). During the time of high inflation a couple of years ago, they were given a one-off payment of 116 Euro. In real terms though, their wages have not increased over the last five years. This increased the resolve of the CFM workers to continue fighting.
The coalition government of the SPD, Die Linke and the Green Party, which governed from 2016 to 2023, promised to reintegrate the outsourced services into the Charité public sector hospital, but never fulfilled that promise. Neither did the current CDU (Tory) and SPD coalition government…
The current strike
On the 2nd of April an indefinite strike for equal pay started, 99.3% of trade union members had voted in favour &#8211; around half of the 3,000 CFM workers are union members and around 600 to 700 took part in the strike. During that time there were various public sector strikes going on in Berlin, amongst others of public transport workers. These strikes were also led by Ver.di, but they were settled through arbitration by the politicians Matthias Platzeck (SPD) und Bodo Ramelow (Die Linke) and there was no organised attempt to link them up with the CFM hospital dispute. Inside the hospital, nurses and other directly employed workers took up some of the tasks that were affected by the strike, which weakened its impact. The hospital management did not have to cancel any operations or close any beds due to the strike. This is a major issue that we are also seeing coming up in the <a href="https://www.vitalsignsmag.org/posts/100-days-strike-of-phlebotomists-in-gloucester">current strike of phlebotomists in Gloucester.</a> There was no solidarity from the doctors in Berlin. Ironically enough, the strike was primarily organised by ‘organisers’ from an outsourced organising company that had been engaged by Ver.di &#8211; the contract with that company ran out in May, at a peak point of the strike. Apart from these problems, friends who supported the strike reported that the cohesion was good and the strike assemblies lively, despite the various language barriers amongst workers. At some points the assemblies decided to stage spontaneous and loud demonstrations through the hospital with around 200 workers participating.
The legal jungle
After only three days of strike action, the trade union had to call it off again, after CFM management went to court in order to enforce a minimum service agreement. According to the court ruling the CFM workers are allowed to continue the strike, but as hospital workers they have to agree to a minimum service, meaning that the number of strikers was legally limited. Like during the recent nurses strike in the UK, the legal ‘minimum staffing level’ was often higher than the normal day-to-day staffing level, e.g. in some porter areas where usually eleven colleagues would work, the minimum service agreement prescribed the presence of thirteen. Despite all these hurdles, the workers maintained a combative atmosphere and staged various demonstrations &#8211; you can watch a video with interviews <a href="https://labournet.tv/en/videos/hospital-workers-on-strike">here</a>. During one of the protests, workers tried to force politicians who had an important dinner and were being put up in a five-star hotel into direct negotiations with striking workers, an effort that was stopped by the police.
Solidarity funds
Given that it looked like a long strike and that the union strike money had been modest at the beginning, a group of supporters around the group ‘Gesundheit statt Profite’ (Health instead of profits) started a strike fund campaign and, together with others, gathered 60,000 Euros. This put pressure on the trade union to increase the strike money to 100% of the basic wage. The union also claimed to have no money for the planned ‘end-of-strike’ party, so the group of supporters paid for it with money collected during the dispute.
Stop and go
Unfortunately, the union decided to interrupt the strike for negotiations on the 24th of May 2025. Management knew how to drag out the process of negotiations, so that the strike only continued again on the 30th of May. This left a lot of workers confused. Not only because the bureaucratic exercise seemed to interrupt the momentum, but also because the picket lines were used as strike assemblies to pass on information. Without these pickets during the negotiation interruption, the flow of information was interrupted and the mood dampened. During the dispute in 2011, strikes were continued not only during, but also after negotiations &#8211; not only in order to keep up the pressure, but also in order to allow workers to discuss the outcomes.
The outcome
After 48 days of strike the agreement is a mixed bag. The main issue is that the CFM workers are still outsourced and that they still have a different collective agreement, which divides them from their immediate hospital colleagues. According to the agreement their wages will be equalised with the public sector by 2030. This means that they will earn between 300 and 1,000 Euro (before tax) more per month by then, which is considerable. This is a long contract of 4.5 years, during which CFM workers are not allowed to go on strike and the contract will be voided. Management can cancel the contract if public sector pay increases by more than 3% &#8211; to avoid having to pay an additional increase of the CFM wages. On top of this, under the new contact, union members get an extra two holidays per year.
Conclusions
The main issue of the strike is that workers in the same hospital, who are members of the same union, didn’t manage to join up and struggle together. It would not even be necessary for the public sector hospital workers to go on an official strike. It would be enough to ‘work-to-rule’ and refuse to take on extra work when porters, cleaners or house-keepers are on strike. For that to be possible, the workers would need to develop direct forms of organisation, such as <a href="https://www.vitalsignsmag.org/posts/struggles-in-the-1970s-at-the-polyclinic-in-rome-part-1">common assemblies or joined committees</a> where decisions could be debated and coordinated, and a common struggle could be conducted.

48 days of strike by outsourced hospital workers in Berlin

Another short text from &#8216;Nous ne serons plus patients&#8217;, a book by health workers from France. We translated two texts already, which can be read <a href="https://www.vitalsignsmag.org/posts/nous-serons-plus-patients-a-rebellious-health-workers-book-from-france">here</a> and <a href="https://www.vitalsignsmag.org/posts/hospital-struggles-in-france-from-1968-to-today">here</a>.
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Testimony of a health care assistant
Hospital Purpan in Toulouse, 2019
Today I started work at 7am. Two patients had been waiting for hospital transport since 5 o’clock in the morning. Now it is 12:53 and they are still waiting for the ambulance to take them home.
A few weeks ago I went on strike, for better working conditions, for better care for the patients. As a result management has told us that they will add a second team for the discharge process. But today no one is able to tell me if this second team exists in reality, or just on paper.
What should I tell my patients who have been laying in stretchers for 20 hours, just because there are no means to bring them home? The truth. I tell them the truth. And still I apologise. Because despite all my efforts, the issue is not taken up by upper management, “we won’t call the senior administrator about a hypothetical problem” &#8211; hypothetical?!
Yesterday. Yesterday I was supposed to discharge and transport three elderly patients, who came to the hospital, because they were unable to stay home &#8211; whether alone or with someone. They were sent back home straightaway, not in order to get rid of them or because nothing could be done for them. But because there was not a single bed available in the hospital. Two of them had been discharged from the same hospital the day before, for the same reason. There are no beds, neither in the hospital, nor in the surrounding clinics. Nowhere!
When one asks for beds, that’s real, that’s not for show. People need them. I hate having to do this. And I am ashamed that I didn’t have the courage to call the son, who told me on the phone in the morning: “it is unacceptable that you have discharged my mother” and to whom I had responded sincerely “you are right, this should not have happened”. How can I call him four hours later and tell him that I will send him back his mother, who he cannot take care of, because she has special care needs which should be taken care of in hospital? I can’t. So I didn’t do it, I didn’t have the courage.
And this broke my heart. This lady, 90 years of age. Who didn’t dare to ask to be changed for hours. My colleague and I finally did it and while changing her we realised that this lady was wearing three layers of underwear in order to ‘protect’ herself. She had tears in her eyes and was ashamed. She told me “I am sorry and I feel ashamed, but they don’t help towards buying pads anymore, I had no choice”, then she told me that she had been a health care assistant herself… I tried my best to reassure her. But I felt really bad… She had no means to keep her dignity. How is that possible?
And this patient, she arrived asleep (fortunately), knocked out by multiple types of drugs. She had left the hospital on the same morning, after having been aggressive towards care staff and forcing the hospital security to run after her drug dealer. After my shift, once she woke up, she was violent towards hospital staff again. Her favourite game was to spray around her blood, saying “this is how you die of AIDS”. And yes, she had various serious and transmissible diseases. And yes, she will return and be aggressive again… until what exactly has to happen?!
And patients with dementia, for whom our services are not adapted, who wander around, enter other patients&#8217; rooms and attack them. Do you find that normal? These could be your parents, your siblings, children, friends… this could be you!
We don’t have the means to do our work. We don’t have the means to take care of our patients and to protect them. We don’t have the means to protect ourselves.
It’s about time that this changed!
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A strike on the roof 
Le Havre, 20th of March 2018
For two weeks, a dozen care workers have been living and sleeping on the roof of the psychiatric hospital of Le Havre in order to denounce the bad state of their working conditions. Several testimonies had been published in Paris Normandie, which made clear that the care provided in this establishment is not exactly ‘humane’. “In the emergency department they cram together fifteen patients in rooms that are made for five”, says Olivier Legat, chief of psychiatric nursing. A nurses asks herself “How are you supposed to get better in here?”. Two beds had been added to her ward, one is a stretcher, the other one made up by putting two benches together.
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A hospital welcome committee for the Minister 
La Rochelle, June 2019
Around 150 striking workers from the hospital group La Rochelle-Rochefort, who had been joined by workers from emergency departments from neighbouring areas, played cat and mouse with the police, overflowing the emergency department, while following Minister of Health Agnes Buzyn in order to shout slogans at her: “Means for the hospital!”, “The hospital is not for sale!”, “Hospital in anger!”. After a visit of two hours the Minister of Health was let out through a back entrance of the hospital, according to AFP.
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Film – General strike of health workers in Italy, November 2024

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‘La Grande démission’ – The Great Resignation in Canada

48 days of strike by outsourced hospital workers in Berlin

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