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

Life and struggles of a nursing apprentice in Germany

At Southmead hospital, bank workers and supporters recently handed over 280 signatures of a petition<a href="https://www.vitalsignsmag.org/posts/no-exclusion-of-bank-staff-from-the-pay-increase"> against the exclusion</a> of bank staff from the pay increase. The question, as always, is: what happens after a petition. What happens if management decides to ignore it or comes up with empty replies? 
The recent form of action taken by health workers in Germany could be a next possible step: the ‘active lunch break’. We spoke to a friend who is employed as a nurse in Dachau hospital, who we had interviewed about <a href="https://www.vitalsignsmag.org/posts/struggles-of-an-independent-workers-group-at-a-private-hospital-in-germany">his general experience </a>before. You can watch a short video of their action <a href="https://labournet.tv/en/videos/break_dachau">here</a>.
The background
Like in the UK, many hospitals decided to outsource certain hospital tasks to separate companies, such as portering, cleaning, catering, and bed wash. With outsourcing, the pay and conditions of the workers deteriorated &#8211; see, for example,<a href="https://www.vitalsignsmag.org/posts/48-days-of-strike-by-outsourced-hospital-workers-in-berlin"> the recent strike of outsourced CFM workers</a> in Berlin. In the hospital chain where our friend works, they outsourced the ‘bed service’ on the wards, meaning, workers from a subcontracted company would strip the beds after patients left, clean the bed and surfaces with wipes and remake the bed. The wards where our friend works are fairly big, with up to 53 beds, and a high patient turnover of 20 patient admissions and discharges per shift. 
A health reform some years back introduced a ‘flat-rate-per-case’ system, meaning, hospitals are paid a specific amount for a specific patient treatment, disregarding whether it takes shorter or longer. This encouraged hospital management to speed up processes, focus only on lucrative treatments and to reduce care staff in order to maximise profit. Outsourcing increased after that reform. The results were so bad that a second reform was introduced, which excluded ‘direct patient care’ from the flat-rate-system, which meant that work of qualified care staff ‘on the bed side’ is reimbursed by the health insurance. 
This changed the strategy of hospital management: they now decided to let nurses and health care assistants do tasks again that were outsourced before, knowing that they would get their money back. Tasks like bringing food to patients are done by ‘care staff’ again. The care staff being already overstretched, the last straw was that management ordered them to do the ‘bed service’ on top of their usual duties. The outsourced workers who had done the task before were blackmailed: either you qualify as a care worker, or you lose your job. Some of the outsourced workers spoke only rudimentary German or were older, which meant that they didn’t feel confident to do the apprenticeship. At Dachau, dozens of them lost their jobs.
The resistance
Hospital workers in Erfurt collected 800 signatures against the attempt by management to force care staff to do the bed service. In Dachau, a workers group distributed leaflets inside the hospital, calling for a protest outside the hospital during lunch break. Management tried to enforce a ban on leafleting, but by that time many colleagues had taken pictures of the leaflet and forwarded it to others. To join together during lunch break and make the resistance against the management measure visible is a first step. After the lunch time protest the discussions on the wards about the bed service conflict intensified. Other steps should be taken on the wards themselves: workers can decide together, whether they prioritise care of patients on the ward, or changing beds and cleaning.
Our problem as workers is that cleaning and making beds sometimes gives us a needed break from the intensity of patient care! So we should not argue that we are ‘too good’ for these kinds of tasks. Sometimes it is nice to escort a patient to imaging, because it helps us to recover from drug rounds or patient washes. What we need is enough staff, enough time to do a variety of tasks. We also want to minimise a repetitive hierarchy on the ward, where we are reduced to doing only certain tasks. 
Let us know what you think!
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‘Active lunch break’ at hospitals in Germany – A short video

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’

Film – General strike of health workers in Italy, November 2024

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