This was a first informal gathering of health workers from various countries, eager for a fundamental social change from below. If the debate seems relevant to you feel free to get in touch, as we plan further meetings in the future.

The participants

Around 25 of us gathered from various locations: Germany (Freiburg, Munich, Frankfurt, Berlin, Leipzig Tuebingen, Dortmund, Muenster), Austria/Turkey, England (Manchester, Bristol), Hungary, France (Toulouse), Brazil (Sao Paulo), Sweden (Stockholm) and Serbia.

We have different jobs within the sector: nurses (palliative care, intensive care, local hospital, hematology, gynecologist, hemodialysis, home for disabled people), pharmacist, psychotherapist, ambulance worker, private health system worker, emergency doctor, midwife, retired nurse working in domestic care, physician, physiotherapist, psychiatrist, labour journalist, occupational therapist.

Some are part of political organisations and some take part in autonomous (health) collectives. Some are representatives in mainstream or rank-and-file unions, some are not. Some or not yet organised in any kind of structure.

Our organisational experiences include, amongst other initiatives: Health Workers for Palestine, Antimilitarisation Health Worker Group, Association of Democratic Doctors in Germany, SAC union in Sweden, Collectif Autonome Ambulance in France, Workers Voice in Serbia, Plan C and Vital Signs in the UK and Viva Sus in Brazil.

Our expectations of the weekend were to exchange experiences and to discuss current struggles and organisational initiatives. Organising in the health sector is difficult, partly due to atomisation, partly due to repressive legal measures against industrial action. We also wanted to talk more about the militarisation of the sector.

Introductions of the group initiatives

These are short group presentations, a non-exhaustive glimpse of the experiences in the room…

Viva SUS, Brazil

Viva SUS is a collective of (mental) health workers in Sao Paulo. It started in 2012 after a movement against privatisation of health. They started independent meetings, produced pamphlets and social media content against privatisation and abuse, and linked up with neighbourhood organisations, groups for reproductive rights, against police repression etc. You can read more about Viva SUS here. A presentation on the situation in Brazil is here.

SAC, Sweden

SAC is a rank-and-file syndicalist union, primarily strong in cleaning and construction. People were disappointed with the main nurses’ union, in particular about their position on the genocide in Palestine. Nurses decided to leave the union and to organise independently within SAC. There are still demos for Gaza every Saturday in Stockholm, people were disciplined for taking part in scrubs. The group engages in anti-racist work in the health sector and against a current reform that wants to restrict access to health care.

Vital Signs Magazine, UK

A small group and publication for two hospitals in Bristol. Engaged in small disputes and discussing how they relate to the question of ‘worker control’ and an alternative to the capitalist health sector. You can read more about Vital Signs here.

Group from Hungary

From anarcho-communist background, interested in workers’ inquiry and revolutionary mapping. Engaged in workers’ surveys from different sectors. Trying to map the health sector around Budapest and the wider supply-chain. The survey is also trying to address the issue that workers see themselves as middle-class and they see anyone who talks about workers as ‘communist’. Mapping seems important, as a protest movement in 2018 against a labour reform only managed to blockade the government building, but not the circulation of capital. A longer description on the situation in Hungary is here.

Autonomous Ambulance, France

Collective of health workers and non health workers who provide medical care during protests and for refugees in Calais and elsewhere. This network has existed for ten years and is a good way to meet other health workers in the movement. There is also an overlap with the Cafe Sante in Toulouse, which supports health workers and patients in their struggles, e.g. by handing out information on worker and patient rights. Discussions how to struggle effectively in the health sector, as the “government gives a fuck about strikes in emergency departments”. They also published two books, on historical forms and examples of struggle and on who benefits from the digitalisation in health (insurances, software companies etc.).

The current moment in the health sector

A comrade from Vital Signs Mag presented a short input on the general moment in the health sector. The input can be read here.

• Restructuring

We primarily discussed how the restructuring of the sector took place since the 1980s, the commonalities and differences according to region.

In France we saw a managerial turn in the 1980s, which introduced treatment related payments – a precursor of the DRG (diagnostic related groups) system. This led to various struggles, primarily led by doctors, e.g. in the form of ‘data strikes’ and the refusal to code particular treatments. Hospitals started to focus on treatments that paid more, which led to deprivation in areas that were not remunerated, such as psychiatry, maternity and emergency care. During the 1990s this process was further intensified with the digitalisation of health documentation and the current introduction of ‘telemedicine’ also works towards further commodification and the closing down of health facilities. People can now take their own blood pressure etc. in (supermarket) pharmacies and talk to doctors online. Digitalisation is also used in the current ‘reforms’ which want to stop free access, for example for people without papers.

In Germany the coding for the DRG system worked differently, in the sense that it led to an increase in the number of doctors, while it was mainly the nurses who opposed it. Since then there has been a back and forth about which tasks are included and reimbursed as part of the DRG system. In private hospitals certain tasks such as inner transport, bed cleaning and patient food services were first outsourced, but once the ‘bed-side’ work of nurses was reimbursed, these tasks were pushed back on to the nurses.

In the UK doctors are supposed to do the DRG treatment coding during their working day, which takes time away from actual medical work – but it is not mandatory. In addition, much of the work is now also done on mobile phone apps, which means that doctors often do the work outside of official working hours. In that sense the current campaign against the software company Palantir and its use within the NHS has to be expanded: the data platform is not only politically questionable, but also cumbersome to work with. We asked ourselves how performance and financial management is combined in the UK and how it impacts on our emotions (“moral and spiritual injury”).

In Sweden the coding of the DRGs is done by the bosses. They use this and the wider digitalisation to intensify work, e.g. nurses are supposed to document how long certain patient movements take. This is then used to cut staffing. The main discussion would be how to ‘slow down’ certain processes, in order to retain staff and have more time for patients. One form of resistance against this form of surveillance and the resulting lack of staff is to issue datix reports or formal complaints regarding patient safety. A strike in Stockholm gained minimal extra-time for certain work tasks. At this point we compared the situation to the UK, where the datix and complaints system is often used to individualise discontent. 

In Brazil a new law is supposed to introduce productivity norms and coding within the mental health service, which reduces the time for each therapy session and limits other forms of therapy, such as group activities or home visits. The process started in 2012. The metric the productivity scheme applies is solely focusing on ‘labour’, it doesn’t say anything about outcomes or ‘minimal service’ provisions for the local population. Some people who questioned this scheme were fired. Officially there is an ombudsman system for complaints, but like in the UK this system individualises and frustrates workers. There is also more and more surveillance and policing within hospitals, with cops often abducting homeless people right from the health services.

• Going on strike

In France, as the state can ‘requisition’ health workers who go on strike and order them back to work, people had to develop counter-tactics. As the ‘requisition’-paper has to be handed over personally, workers on strike tend to stay at other places than their home address during strike days. Strikes tend to be separated by profession. Most of the strikes actually happen in local community health centres and are led by self-employed therapists who oppose the government budget plan. There are also various strikes against the closure of local hospitals and services. The link between the local population and the strikers is important: in the north of France the local population used medieval catapults to attack the town hall and the maternity ward got occupied. Unfortunately Covid interrupted a wider health movement and there were no strong links between health workers and the Yellow Vest movement, although many health workers took part individually. In Toulouse a collective ‘Health Workers in Struggle’ tries to bring health workers, patients and health activists together to support struggles. There is repression, for example in Toulouse, emergency nurses were sacked six months after they went on strike. Other forms of struggles are roof occupations, e.g. by the ‘black scrubs’, who are mental health workers protesting against a lack of resources. They also went on hunger strike. In a small town in the south of France people recently went on strike and protested against the closure of a maternity ward, 150 people came to the assembly, out of which 30% were strikers. The strike lasted for two months.

In Germany, the union calls only the main hospitals out on strike, e.g. for better staffing. Out of 1,800 hospitals, only around 20 took industrial action – which is a good strategy in terms of union budget, but doesn’t involve many workers. In terms of strike the ‘minimum service’ is negotiated between management and top layers of the union, which means that patients are often removed before the strike takes place. This leaves strikers in a passive position. Officially you can only go on strike when the collective bargaining agreement between union and management runs out. Often the agreements are very complicated, for example the agreement on minimum staffing levels. Most workers don’t understand them and/or management can interpret them in their favour. Some areas are not allowed to go on strike, e.g. ambulances that belong to the fire fighters. Many hospitals are still run by church organisations, which also limits trade union activity.  Many new nurses are migrants, who depend on visas and often on housing from hospital employers. We have to discuss other forms of collective actions, apart from the ‘official’ strikes, e.g. work to rule. Overall, nurses wages have increased quite a lot, compared to other skilled workers wages and now range between 3,700 and 4,600 Euro before tax. In this sense the health workers were successful fairly quickly, but the current health reform threatens to take this away again. In this sense it is ironic that the recent collective agreement strikes finished two days before the health reform was passed in parliament – and one day after that the union sent out emails saying that we have to do something about the health reform.

In the UK, when it comes to strike action and ‘derogation’ there is the usual back and forth between the national leadership of the BMA (doctors union) and NHS management. Often staffing is better on strike days compared to the average working day. Four years ago we had the first strike of nurses in 30 years, but only one of several unions that represent nurses went on strike. It is difficult to get 50% of all members out to vote, in particular when it is a national ballot. Unlike in Germany the focus was on wages, although the argument was that with higher wages more people would work in health and that would guarantee better staffing – which is a weak argument. At the same time wages are central, in particular for the lower wage bands: each time the government increases the minimum wage, the cleaners, health care assistants, porters etc. drop below the minimum. 

In Sweden it is hard to go on strike as it has to take place within a collective agreement. There was a strike two years ago by nurses, about wages and reduced working hours. It stopped because of employers declaring to go on holiday – no win, only 10 minutes shorter night-shifts as result. In Sweden, strikes generally only take place when the collective bargaining agreement between union and management is up for negotiation (and thus not in effect). Typically many employers in Sweden are covered by collective agreement. In 2019 new regulations to the labour laws were passed which expanded the peace obligations related to collective agreements. Previously, unions that were not bound by a collective agreement with the employer were free to take industrial action against an employer that had collective agreement with other unions. This opportunity is since 2019 severely restricted, and can only be exercised under particular circumstances. Regarding the nurses strike in 2024, there was a general shortening of weekly work hours for nurses working night or rotating between day- and night shifts. It is a bit unclear exactly how much impact this had, as many workplaces already more favorable local agreements regarding reduced working hours for rotation and night shifts.

In Brazil strikes only tend to happen when the workers are not paid. Legally, workers can go on strike independently without major legal hurdles. Most of the health services are outsourced to third-sector companies, where the union density is low. Some of these companies are attached to religious organisations, which is problematic, e.g. in some cases they stopped providing birth control services and resources. There are autonomous encounters in neighborhoods.

In Turkey strikes are not allowed for nurses in public hospitals and you can’t risk to lose your job. There are mainly strikes by doctors, nurses are just seen as ‘helpers’.

In Hungary the society is atomised and the right of healthcare workers to strike is extremely restricted by law. In the healthcare sector (particularly for those in public-sector employment), the right to strike may only be exercised on the basis of a separate agreement between the government and the trade unions concerned. In 30 years of working as a nurse the comrade has been on strike for two hours. The main tool for protests are demonstrations, but there are also forms of ‘faceless resistance’ that workers can adopt.

• The militarisation of the health sector

A comrade from the Association of Democratic Doctors from Germany presented an input on the militarisation of the health sector. 

In Germany the militarisation of the health care system intensified with the Russian invasion of Ukraine in 2022. The governmental goal is to increase the military spending to 5 % of GDP. Amongst health workers, ‘war’ is presented like any other emergency situation or adverse incident. There are specific plans for the case of war e.g. shifting to disaster medicine and prioritising military staff. A law has been passed that allows health workers to be ‘conscripted’ in case of war. The head organisation of all trade unions does not criticise militarisation. New infrastructure projects are now assessed whether they could help with military logistics and manufacturers can hope for subsidies if they invest in ‘hybrid’ production capacities, meaning, capacities to switch to re-armement production if needed.

In the UK the situation is different, in the sense that the NHS was founded during the Second World War and is historically linked to the military. In the 1942 Beveridge report it was stated that the average population is too unhealthy for military service and that the health service has to improve general health for that matter. There are a few dedicated military hospitals, such as in Birmingham, but the NHS in general is already integrated in potential war command structure. The university hospitals tend to cooperate more closely with the military. Recently the University of Bristol has officially joined the Defence Universities Alliance (DUA), which is part of the UK Government’s £182 million investment in growing military training and future ‘career opportunities’ for students in the army. 

In France a so-called ‘medical reserve’ was registered during Covid, including retired health care professionals and volunteers. This register would also be applicable in a situation of war. Comrades in France held an international meeting of health workers to discuss the issue of militarisation in May 2026. In France you can only legally refuse to offer medical help in case of abortions, while you could be obliged to provide medical help for the army.

In Sweden the militarisation and anti-Russian propaganda has increased since Sweden joined NATO recently. Even the Left Party in parliament accepted the war credits. ‘Requisition’ will consist less of sending people to the front line, but subjecting their work to the war effort.

In Brazil it is clear that if Europe goes to war or the US war expands, there will be additional need for resources and it is clear that countries like Brazil will be supposed to deliver resources. The tendency towards a return to dictatorships is linked to this scenario.

How to organise at work

As most of us are pretty isolated in our workplaces we talked about how to start organising things at work. This can be tricky, as we are often confined to single wards and it’s not always easy to move around the hospital.

Short example of an apprentice campaign in Bristol, where it was relatively easy to walk through wards, find other apprentices who had similar problems and add everyone to a WhatsApp group and a collective grievance.

Another report from working in a church-run hospital with no union structure, while being on rotation and changing wards frequently.

Sometimes being in a union protects you a little bit (France) or allows you to move around more as an official rep (UK), but they also tend to restrict your initiatives (Germany). It’s important that the meetings are also fun (Brazil).

We often see hierarchy issues, when it is difficult for doctors or even nurses to engage with health care assistants or other support workers, as doctors and nurses also have management functions.

In France it is possible to form an ‘association’ which gives you certain rights as workers.

During a recent bus drivers’ strike near Munich, hospital workers linked up with them and together took over the fairly boring local trade union branch meeting.

The situation differs significantly when it comes to distributing leaflets at work. In some situations there is no risk, in others management is more repressive. It can be tough when you get singled out and abused by management, it needs time to recover from that.

It was recommended to read this longer interview about concrete experiences of organising inside and outside of the union in Germany.

We all agreed that apart from the day-to-day struggle we also need a longer term strategy and other forms of organising. Comrades from the UK referred to consciousness raising groups amongst health workers about how we relate to patients.

How can we continue?

• The question of DRGs and coding

We decided it would be good to compare the way that DRGs and ‘coding’ of treatments has been introduced in the different countries and how management is using it to commodify, compare and intensify the work. We could work out common questions and then write short reports from each country:

What is the name of the system?

How is it formally regulated?

Who is responsible for the coding?

What digital or software tools are used?

What is the impact on workers and patients?

How is it used to change the work organisation?

What kind of resistance emerged?

How much time do you spend on it per week?

What would be ways to block the system?

What are the contradictions of the system: on one side it is necessary to have a rough understanding of labour time for certain treatments in order to be able to prioritise and allocate labour, on the other side this is often attached to financialisation and surveillance?

• The question of patient organising

How to include patients in the struggle for health care?

Link up with « le château en santé » in Marseille 

• The experiences with self-organised health services

In Germany there is a lot of talk about ‘poly-clinics’ but only two are actually functioning, one in Berlin and one in Hamburg. The problem is resources. We find ourselves in a peculiar situation: in Freiburg the state issues anonymous ‘treatment papers’ for refugees, which allows them to access health care for a certain amount of Euro. While many medical students organise around the provision of migrant health care, there is little activity ‘as workers’ in the hospitals. 

In France there is a fair amount of state subsidies for self-organised clinics, there is a discussion about how to relate to state money – interview with self-organised clinic in Marseille. 

In Europe there are regular meetings of a network of autonomous clinics, would be good to know more about them.

• What could be the next opportunity to meet?

1st to 6th of September in Cologne: Anti-militarisation camp in Germany

Spring 2027 in the south of France: Gathering around the organisation of autonomous health struggles 

Before the next summer camp in 2027