We publish the second chapter of a book on the workers’ and patients’ struggles at the university clinic in Rome in the mid-1970s. The introduction of the book can be found here and the first chapter can be read here. The first part of the second chapter is here. We recommend watching this inspiring documentary about this historic movement in tandem.
This part provides a sharp account of following struggles: against over-time and for better staffing levels; the trade union campaign versus the autonomous workers’ initiative; the struggle of temp workers for permanent contracts; the fight for free health service and against private hospital beds. These issues are still relevant today!
The polyclinic collective formed part of a wider network of political committees in major workplaces and working class areas; you can read more about them in these articles on Magneti Marelli, on the committees at Alfa, Siemens and Pirelli, on Senza Tregua and the political committees in Veneto. The collective’s outstanding character was based on the fact that it included medical students, nurses, porters and doctors, and aimed at the socialisation of the divided knowledge within a project of workers’ control of the clinic. Patients were participating in the regular assemblies of the collective. Workers fought for equal conditions between permanent and precarious staff, they imposed free health services for local workers against the private interests of the bosses of the clinic. The collective supported the occupation of administrative buildings for the establishment of a children’s nursery for hospital workers. They also joined a feminist occupation of an operation theatre for free and safe abortions. The collective was locally linked to similar collectives within the energy sector, railways and various working class neighbourhoods.
In terms of understanding, the comrade uses the word ‘barons’ to describe the very elitist, if not semi-feudal character of the medical and university hierarchy at the time. Many of the bosses of the university clinics were embroiled in corruption and had close links with conservative, religious and sometimes fascist circles. She writes about the ‘university workers’ struggles’ for equal wages with the workers directly employed by the hospital – at the time university contracts were used as a form of subcontracts within the hospital, in order to pay less for the same work. So the ‘university workers’ are actually medical workers in the polyclinic.
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The first struggle against overtime and for an increase in staffing levels
On the 12th of November 1971 an assembly called for by workers in the clinics and hospital pavilions addressed the problem of insufficient capacities of all hospitals in the region of Rome and the lack of care staff, which pushed the workers to work overtime (the Collective spoke about the “corruption created by the chase for overtime”).
From a leaflet that was drawn up at the end of the assembly: “Due to the ever increasing lack of capacity of front-line hospitals, while facing a general increase in local population, the situation in hospitals in Rome has become untenable. This is true for all services, but in particular for inpatient care, where the limit of bed space has been excessively exceeded and which leaves the staff unable to provide adequate care for the patients.”
Stating that the various responsible authorities (both political and medical) don’t do anything to resolve this situation, the workers decided to enter the struggle for the following goals:
“1) Abolition of overtime (which should be limited to those situations of acute staffing shortage where the safety of the patient is at risk) in order to facilitate the recruitment of new qualified staff;
2) Generalisation of the struggle together with the patients;
3) Creation of collectives and rank-and-file committees in every hospital, as a first moment of self-management of the workplace”
(15th of November 1971)
This call was distributed by the Collective of workers and students during department assemblies, trying to transform it into a moment of unity between patients, workers and doctors, for the control from below over recruitment and care service.
The issue of overtime is amongst the most delicate ones for the workers in the clinics. The reason for overtime lies in the chronic staffing shortage and in the convenience for the administration which doesn’t want to pay social security charges for further employees. Beyond that, the workers’ need for additional income to top up their very low wages also plays a role, as we will see. One of the main problems is the fact that overtime can be used as a weapon of blackmail (otherwise we could not explain the run for these extra hours, which at that time were paid at only 300 Lire): the head sister or nurse in charge allow those people to work overtime who they want to reward and the baron makes clear that without working overtime there won’t be any career advancement (the barons also use this blackmail when forcing workers to work extra shifts in their private clinics, which concerns first of all specialised staff like radiographers, who are already ‘used to work with them’ and who they want to bring along with them). [9]
In this way the overtime turns into a “stick and carrot […], a very effective weapon that pits one worker against the other, makes them take part in the bosses’ attacks on the working conditions and allows for a more efficient exploitation, which exhausts and destroys the will of the workers to struggle”, according to the Collective.
(22th of October 1971)
The most severe consequence of the increase of overtime is the deterioration of the conditions for patient care: overtime usually replaces a worker for a whole shift, which means that instead of 8 hours, people work 16 hours (which is called ‘long day’ or ‘working a double’). It is obvious that in the second shift, workers are much more tired and less able to confront the various problems related to providing health care. Also the problem of inadequate training for the job task reappears, because on the second shift the worker can be allocated to do any job, even jobs they haven’t done before. Therefore the struggle against overtime involves the demand for more staff, in order to provide better care: to eliminate overtime, a certain ratio between staff and patients is needed, including extra staff to cover workers who are on annual leave or off sick (issues which are currently solved by using workers as ‘day labourers’). The question of overtime (which is a problem for the entire working class, in particular during moments of heavy attacks on the working conditions) was raised by the Collective, bearing the specific conditions of the hospital in mind, where workers provide a service for other workers, so that it could become a connecting element between workers and patients (and conscientious doctors). The Collective chose this path openly: “The first step is taken. We have decided to reject the overtime, which is a shameful stain that the bosses have planted deliberately on the workers’ faces. We are ready to redeem this disgrace by enforcing the recruitment of more staff, controlled by the department assemblies, held by workers, patients and doctors.”
(28th of November 1971)
Nevertheless, this action against overtime met with great hostility within the SUNPU trade union, which saw the issue only from a monetary point of view: “overtime is paid little, let’s make it be paid more”. This was a discourse that ended up making overtime look even more desirable, far removed from the step to eliminate it. This created confusion amongst the workers and a set-back for the struggle. The Collective observed: “Us workers have been railroaded into a shady maneuver which tried (perhaps successfully) to make us lose sight of the goal for which we have always battled: the emancipation of the working class from exploitation. We have been fooled by the promise of a substantial increase of our wages through the regrading of wage categories, the prospect of a new employment contract and through working overtime.”
(18th of November 1971) [10]
In this way the proposal of controlling the recruitment of new workers from below – although it managed to become a goal of the movement – didn’t succeed to turn into a form of mass struggle at this point in time, Nevertheless, it dealt a first blow to a typical instrument of baronal power and to a cornerstone of the functioning of the hospital, even though the refusal of overtime was practiced only by the most conscious workers. Consequently, the Collective linked the problem of overtime more directly to the problem of the transferral of employment to the regional hospital administration, which would result in a higher basic wage rate, and to the demand for an increase in staffing, which became an essential part of the struggle platform. [11]
The trade union and the initial forms of independent struggle
After the unfortunate stance [sortita] of the trade union regarding the valorisation of research ‘activity’, the SUNPU started a more simple agitation in mid-January, for the ‘equalisation’ of the stipend of the workers in the clinics with those of the hospital workers. The economic aspect is certainly one of the most evident of the divisions between workers in the clinics and workers in the hospital. The latter receive a stipend, which is renegotiated every three years and which pays fully towards the pension fund. It is higher than the one of the workers with university contracts, perhaps because the hospital pay is higher at each and every level, or because the workers with university contracts are always paid less than the wages that correspond to their professional group in other sectors, or because they are underqualified. The base rate for a porter on a university contract is 59.000 Lire! According to the law 1042 from the 29th of November 1971, this has to be topped up by a non-pensionable payment of 50% of the base rate – in alternative to the share dividend that is paid in the clinics (by charging patients for outpatient services), the so-called ‘la mora’ [‘the cherry’]. The Collective defines ‘la mora’ as a “double-edged sword”, which makes the worker co-responsible for the actual ‘functioning’ of the hospital (“the damned ‘cherry’ that forces you everyday to hope that more patients will arrive who can be abused” – 26th of July 1971). Apart from these two payments a porter has to work night-shifts in order to be able to eat (to be paid the night-shift bonus) and perform dangerous tasks (to be paid the hazard bonus) – and if they have children they might receive a family allowance. But we are always skint and you definitely have to pick up overtime and other extra payments for ‘favours’ that you grant the barons.
From the beginning of the dispute for the ‘equalisation’, the Collective, albeit still in a minoritarian position, created difficulties for the trade union by advancing new forms and objectives of struggle and heavily influenced the way the dispute was led. First of all, because the trade union had to defend itself against all those who saw, in a coherent fashion, that the only ‘equalisation’ that would work in the interest of the majority of workers would be the regionalisation, because it would deprive the barons of a ‘big space to maneuver’ and would prevent them from abusing workers and patients. Initially the SUNPU said that the demand for regionalisation aimed at… dividing the workers, then they contradicted themselves and claimed that the regionalisation would be an automatic outcome of the future health reform; to which the Collective responded correctly: “It is wrong to say that regionalisation would follow from the health reform: this reform will not guarantee the regionalisation (everyone knows that the reform will increase the power of the ministry and of the central state), but only consents to a decentralisation in an economic sense, when it comes to sectorial management”. (14th of April 1972) [12]
The Collective then managed to make a breakthrough by inventing a form of struggle that was very suitable for the goal of becoming part of the regional hospital administration: the struggle tactic to work only from 8am to 2pm, which was a typical practice of ‘work-to-rule’. The workers said: “We want to be part of the health sector with all its implications. As long as we are state employees, rather than employed by the health sector, we will only work according to the regulation for state employees, which first of all means that we won’t work shifts anymore. We all arrive at 8am and leave at 2pm.” This is an impeccable argumentation, paradoxically ‘legalistic’, which demystifies the work in the hospital (which is all about care work, despite its formal subsumption under the university administration). If workers would push this logic to its final consequence (meaning: “from now on we engage only in university research”) they would paralyse the entire public health system and create a difficult situation for the university, whose income depends on the hospital service, or rather on the payments by the proletarian patients.
Apart from the fact that the inconvenience caused for the patients by the workers’ struggle is minor in comparison to the daily inconvenience of ‘baronal medicine’, the positive element of the form of struggle of working 8am to 2pm is that it has less negative impact for the patients than the normal strikes and it is more effective, because it can be sustained for a longer period of time. In fact, strikes are a weapon of putting on pressure that blockades everything for a day, and the responsibility for the inconvenience caused for patients falls back onto the shoulders of the workers (in this way strikes cannot be sustained for long). Working 8am to 2pm, on the other hand, is a struggle that can last longer, and it is ‘responsible’ because by working during certain times the staff does not abandon their tasks. On the contrary, the workers unveil the fact that the administration is to blame if it doesn’t modify the absurd labour relations of its employees and continues to refuse to hire a sufficient number of staff in order to satisfy the care needs. On the other hand it is a form of protracted struggle which gives the administration, if it is willing, all the time and means to solve the issue (by intervening on the legislative level, such as the regionalisation; by hiring more people, which the law 1042 allows etc.) [13], while the staff, by working the hours that they are contractually obliged to, are still being paid their wages and can therefore continue to hold out. The workers see the barons and the administrative hierarchy of the university as the class enemies who instrumentalise the ideology of ‘public services’ and the ‘superior interest of the users’ in order to enforce their capitalist interests. They therefore chose a form of struggle, such as working only the 8 to 14 o’clock shift, exactly because it allows them to challenge the hospital organisation, to beat the barons and to make visible the responsibility of the administration (in addition to appealing to the patients that they become aware of the reasons for their plight and struggle together with the workers).
For the same reasons, despite having been approved by the trade union initially, the struggle was later on heavily attacked in the name of the ‘collective interest’ that should be protected by the ‘public service’. The trade union sees the hospital as an institution that has to mediate between non-antagonistic interests: on one side those of the ‘users’ (all of them equal, without any differentiation of class, perhaps with an paternalistic attitude for the ‘less well-off’), on the other side those of the ‘employees’ (from the porter to the director of the clinic). In this way, the trade union, while affirming that ‘one cannot harm the users’, maintains that also the administration is not an enemy against which one has to battle, because the administration… “that is us” and therefore the only problem is that of implementing a reform, meaning, a democratic management of the administration itself. And the barons are also only seen as enemies as far as they are owners of private clinics or keepers of an ‘archaic’ autocratic power that should be overcome with a reform, but not as part of a hierarchy of the university administration, of research and education (as such they are only considerate as managers of a service in the ‘public interest’).
As a result of all this, the union only mobilised the workers for demonstrative actions, such as the general strikes for the reform (which are also ‘harmful to the users’) to push for a ‘democratic direction’ within the institutions. At the same time the union continued spreading the view that the institutions and their functioning themselves are class neutral. Although the union had supported the struggle tactic to work only from 8am to 2pm initially, because at the time it seemed useful as a ‘demonstrative’ form of pressure, the SUNPU trade union started to attack this struggle as soon as they realised that the workers made independent use of that tactic and that it strengthened their position. All of a sudden this form of struggle was condemned because it ‘harmed the users’, and the workers who practiced it were labelled as ‘corporative’, because, unlike the other workers in strike, they cashed in their stipend at the end of the month and didn’t lose out on money (as a side note, the porters didn’t go on strike, they only worked a shift pattern which was different from that wanted by the barons; furthermore it is not true that the workers didn’t lose out, because they were only paid their base rate and lost all enhancements and overtime bonuses which were necessary to make end meets at the end of the month).
The workers responded by reversing the argumentation of the trade union: during strikes in factories, the bosses don’t earn when the workers don’t work and are therefore eager to end the dispute as quickly as possible; but at the university hospital the barons continue to receive their stipends (they even earn more now, as they have more time to work in their private clinics) and therefore have an interest to draw things out. This is why also the workers have to organise themselves for a protracted dispute.
As soon as it became apparent that this form of struggle was going to be disruptive, the university administration threatened the workers with heavy repression. The rector asked the prefect to requisition the medical staff and the union, meaning, to legally enforce that they have to work. The unionists walked around and said: “We requisition you!”. In reality, the very fact that management threatened with requisition showed the difficult situation in which the university administration found itself: leaving aside the question of the constitutional legitimacy of the requisition (which is a true impediment of the right to strike) [14], in order to requisition a worker, the hospital director has to demonstrate that the worker belongs to a particular professional category for which they cannot be replaced by others. This legal requirement for requisition immediately clashes with the fact that currently the workers who perform such tasks, such as nursing, actually have a contract of a generic porter, meaning, seen from a purely contractual point of view they are easily replaceable as an auxiliary worker. The administration would be obliged to acknowledge the contradiction which motivated the workers to act – that they don’t have contracts of health workers (also this demystification was obtained thanks to the form of struggle to work only from 8am to 2pm, like other civil sector workers).
Even though many workers realised that the threat of requisition was inconsistent, they didn’t manage to keep up a hard struggle and, despite the fact that no actual requisition was enforced, the trade union was able to make workers retreat into more traditional forms of pressure, such as manifestations and marches, which rely entirely on top-level negotiations and represent in no way the mobilisation and will of the rank-and-file. The trade union pushed for negotiations with the university rector in order to get a pay increase through the possible increase in outpatient fees, despite the fact that the workers’ will to end such kind of complicity had already manifested itself in the struggle against the anti-popular organisation of the hospital (“What does it mean to fight for a pay increase nowadays? It certainly doesn’t mean to hope that a fictitious share of the patients’ fees will end up in our pockets, knowing very well that these service fees are largely paid by working class patients which the system exploits and slowly kills”. (12th of June 1972) [15] After three months of working 8 to 2, and various occupations of the main auditorium of the university rectorate, “strikes, marches, requisitions”, and given that the political elections of 1972 were about to happen, the president of the council proposed an ‘electoral truce’, in exchange for “an extraordinary one-off payment”, which the Camera del lavoro (a board of arbitration) quickly approved and based on which the dispute was declared to be over.
The Collective saw the ‘extraordinary one-off payment’ as a negative outcome: “This alms brings most money to those, who already earn most” (90,000 Lire for the porters, 140,000 for the “Sirs directors”). In the bitter commentary about the closure of the dispute, which happened against the will of the workers who had struggled so hard, the Collective said that the objectives of the workers have not been reached at all [16], “but the hardest blow for the workers was to realise that the instrument in which they placed most of their trust, the trade union, was the element that had contributed to the defeat of a struggle which had been so combative”. (5th of June 1972)
Indeed, during this first struggle many new aspects emerged, which changed the perspective of the workers. One could see clearly that, facing an offensive demand, such as the contractual transferral of the workers to the regional hospital administration, the trade union made a precise decision to choose ‘order’ and the ‘functioning’ of the hospital. During heated debates with the union activists the workers were told: “What the hell do you care who manages the hospital?” – which is a different way of saying that the workers should not raise their heads too much and stick their noses into things that do not concern them (for example, the patient care). The union states that the responsibility for the organisation of the hospital lies with the barons and if anything, it should be up to parliament to remove them, not the workers. According to the union, workers had to obey the orders of the barons for the time being and, beyond that, always obey the orders of someone. Above all, the only problem that workers had to concern themselves with were the wages. To sum up: “Why do you bother with the relations of production, just focus on keeping on producing!”
But the worm of doubt regarding these ‘truths’ had already entered many workers. The groups who organised the 8 to 2 struggle tried to understand what purpose the current hospital serves and if it serves the interests of the workers. And feeling the necessity to extricate themselves from the authoritarianism of the barons, they also started to see the patients in a new light: they were not an object anymore, on which to exercise one’s own subordinated activity, but another human being who also had the need to liberate themselves from conditions of oppression (and the worker realised, certainly more than the patient, that they are both oppressed by the same enemy: that the patient is not an opponent in the competition to win a smile from the baron, but a potential ally in the struggle to deprive the baron from his absolute power).
This discussion had to judge the trade union as an obstacle for the development of new ideas and for future struggles that had to follow from this first experience. This was a crucial moment of collective realisation about the role that the SUNPU played at the university clinic. Many of the current leaders of the movement trace their definitive rupture with the union and their active participation in the creation of the Collective back to this moment. [17]
Precarious labour and the struggle about contracts
On the 4th of March 1972, an open assembly about harmful working conditions took place at the Policlinico. Workers from the university clinic, students and workers from the Tiburtina neighbourhood took part. The initial motivation for the assembly were recent cases of sickness contracted at the workplace. (“Comrade Vinci from the boiler room suffered a heart attack, 22 workers had contracted tuberculosis, hundreds of workers have been poisoned in various factories, something that happened at every workplace.” 8th of March 1972) During this assembly it became clear that the precarious workers were the most exposed to the superexploitation of the bosses and for the first time a discourse started about the need for unity between all hospital workers, from the precarious to those… with a bit more stability.
The first leaflet made a general appeal: “Everyone united (university workers, grounds workers, refuse workers, cleaners, laundry workers, workers in the boiler rooms, maintenance workers, workers of the orthopedics offices, ‘invoicers’, scholarship holders, subcontracted workers and students) [18] against the exploitation by the bosses, for the creation of an alternative rank-and-file organisation”. (8th of March 1972) Only apparently in a random fashion, this list of workers contains side by side all categories of workers which the teaching hospital management divides through various employment relations and which the trade union leads into separate struggles: they are all workers who have in interest in fighting against the exploitation by the bosses which they are subjected to and who gradually understand that they have an interest in the same struggle, despite their specific conditions.
The first workers who started to move were the workers hired through subcontracts. During an assembly that took part at the Policlinico on the 19th of April 1972, a struggle committee for the abolition of subcontracts was elected and the workers affirmed “that they are no longer willing to suffer the bestial exploitation through subcontracts”, which “are nothing else but a cover for mafia-type associations, which don’t apply any capital or means of production and have no other goal but to extort profits from workers through blackmail with unemployment”. [19]
Although “the labour of the subcontracted workers is fundamental for any function within the hospital complex”, these workers have never fought together with the hospital workers, because according to the trade union strategy it is impossible that public employees (like the hospital and university workers) and private sector workers (like the subcontractors), or in other words, that care workers and maintenance workers or ground workers have the same needs. According to the same logic, the dispersion of small companies, the fragmentation of various professional groups etc. impede a stable organisation of the subcontracted workers, who are therefore very weak, also when it comes to the contractual relation with their bosses. Being private employees, they are not even covered by the social benefits provided in some form for public sector workers, and therefore they never find common opportunities for mobilisation together with other workers.
This time, though, the subcontracted workers came to a different conclusion, while discussing the problems at the hospital together with other workers: “we are care workers”, which leads them to join the struggle that had been initiated by the clinic workers and to demand from the regional administration “that all subcontracted workers should be transferred to the regional hospital contract”. In this way, on one hand the isolation of the most precarious workers is broken, and on the other hand it demonstrates that the goal of transfer to the regional hospital contract is able to mobilise a great force (there are 500 subcontracted workers alone) and to obtain results which would not have been achievable in a dispute about ‘equal treatment’ (which the union suggested). Nevertheless, such an expansion also contains risks, if the mobilised forces are not able to push the struggle with might. So it happens that by unifying the objective of clinic workers and subcontracted workers, the latter,for the time being, now also accept the trade union initiative.
The struggle of the subcontracted workers is now subjected to the suspension in the name of “electoral truce”, too, “a truce that imposes on the workers a loss, not only in time, but also in terms of strength: today we saw in still ongoing meetings how our [trade union] representatives accepted, in an entirely defensive logic, the demands of the counterparty. Accepting these demands means to postpone the struggle further and further and to run the risk of demobilising the workers. The meetings in the head offices are presented as decisive and not the mobilisation of workers from below and the forms of struggle that harm the bosses as much as possible and force them to accept our demands […] These things were not said at the meeting, and some members of the Agitation Committee (which was always held in low regard by the trade unions) who tried to say them, were silenced with a vague and opportunistic appeal to worker unity by the trade union representative.” (29th of May 1972)
The struggle of the summer temp workers
The tendency towards a unity of workers that emerged from the struggle of the subcontracted workers was reinforced when workers who were hired on temporary contracts decided in summer 1972 to “not accept the notice letter for their dismissal”, but to enter in struggle in order to be hired on a permanent basis. It was a new occasion to take up the struggle against precarious labour in relation to the lack of staff and the pressure the workers in the clinics are put under. The assembly of the temp workers, which met on the 4th of August 1972, confronted the question like this: “Who are the temp workers? The temp workers are former unemployed who have been hired by the university administration through the DPR (Decreto del presidente della Repubblica) of the 31st of March 1971 no. 246, which allows ‘the temporary employment for an exceptional temporary need of staff’. But are the summer holidays of other workers really exceptional circumstances? All this camouflages a precise case of exploitation and division of workers. Workers have the right to holidays, but the administration cannot make other workers, who will soon be out of work again, pay for the disfunctionality of the sector. On the contrary, it is necessary to increase the total amount of staff and to fight these types of hiring practices, which sees workers being kicked out by the bosses after a short stint of work.” [20]
The temp workers are living proof for the fact that there is a lack of staff (given that there is at least one period during the year where a lack of staff is officially recognised) [21] and they are subjected to a particular regime of exploitation, being forced to work two hours overtime daily that are not even paid and being often ordered to do heavier tasks than they have been hired for – not to mention the fact that they have their dismissal hanging over their heads and no health insurance etc.. It is therefore clear that by defending their own job the temp workers look for a unity with the other hospital workers: “The struggle of the temp workers means the struggle for the unity of all workers, against unemployment and for a real workers’ management of the hospital […] against the exploitation by the university administration which has always maneuvered to divide and squeeze out the workforce.”
In this way, the temps “join the effort of the hospital workers and remind them of a decision that has been made in the general assembly and written about in many documents: the unification of all categories of hospital workers (university workers, hospital workers and subcontracted workers) under regional administration; with the special commitment for all categories to enter the struggle once a single category is forced to enter the struggle.” [22]
Initially the temp workers proposed the following objectives:
* Hiring of the temp workers on permanent contracts through publication of vacancies by the administration according to article no.1 of law no. 1042. This is a temporary objective, leading towards the unification of all hospital workers
* “Immediate cessation of having to work two hours unpaid overtime and immediate payment of overtime that has already been worked.”
The agitation committee of the temps, which acted totally autonomous (despite the “complicit silence of the union organisations, which previously always tried to discourage the new workers, telling them over and over that the struggle for permanent employment was a lost cause” [23]), called for two hours of strike at the beginning of September and decided that when the contract expires, the temp workers “will continue to be present at the place of work until the administration will accept their objectives” [24]: this form of struggle had already been used the previous year by a group of day labourers, which later on had been hired at the end of summer.
Facing the cohesive dedication of the temp workers, Vaccaro and Gianotti (rector and director of administration) chose the path of creating divisions: they proposed to the temps to compete and apply for a total of 120 vacancies. By refusing this proposal and continuing the agitation the assembly of temp workers confirmed:
The logic of a competition for vacancies is a logic of selection and discrimination which tries to divide the workers, ignoring the need of everyone to earn a living;
The proposed hiring process doesn’t apply to the temporary workers as their ability to work has already been verified through their initial employment. It is unclear how a worker should be declared unsuited for the job if that worker has already worked for three months and who has been heavily exploited by disregarding the law (tasks beyond the job description, unpaid overtime, no health provision etc.) [25]
The solution proposed by the administration is partial: they are not interested in the totality of the temporary workforce (the total 276)”
In order to react in concrete terms to the divisive maneuvers of the administration and the complicit behavior by the trade union, the assembly decided to “to create a control commission immediately that has the goal to enforce the decisions that have been made in the assembly in terms of the refusal of the hiring process, defeating in this way any attempt at creating divisions or partial solutions that could be put in place by the servants of the bosses who disguise themselves as representatives of the workers.” [26]
The confrontation became even more heated when the administration tried to suspend and dismiss people before the end of contract. This was an irritated reaction to the fact that the temp workers refused to ‘accept the rules of the game’: when have you ever seen temp workers organising themselves or even going on strike? As a result, the organisation of the temp workers became even more determined and established rules to prevent individual workers being intimidated by supervisors and little managers etc.. Once the contract ran out, every temp worker was supposed to turn up at the place where they had worked, sign into the staff register, even if they had received a verbal or written confirmation of suspension or dismissal. Any communication or objection received by the worker was to be forwarded to the struggle committee and every temp worker was expected to attend the assemblies and agreed actions of struggle (“thereby being recognised according to the Statuto dei Lavoratori [labour law”]). The committee refused “any responsibility in the confrontation of those temp workers who didn’t follow these instructions.” [27]
This forces the administration to revise their position: they receive the struggle committee of the temp workers (and thereby give ‘official recognition’ to an autonomous organisation for the first time) and during the meeting decisions about a hiring process are made: it was supposed to be non-discriminatory, but, in the end it wasn’t officially listed. When the temp workers realised that the rector made promises that he had no intentions to fulfil, they decided to organise a demonstration in order to explain also to the patients the objectives of their agitation. The rector had no better idea than to call the police and attack the demonstration. In a leaflet distributed to the patients the committee said: “Evidently this was the repressive intent of the bosses and the administration. We, though, won’t bend to this intent, because having an income is the right of all workers and, above all, we want that there is better care on the wards. In the hospitals, workers who have been exploited at their workplace recover and we want there to be at least more staff to care for them.” [28]
With this new situation, where the organised precarious workers opposed the administration, which reacted heavy-handedly (with a trade union that discouraged the struggle also by supporting the hiring scam proposed by management) a wider mobilisation emerged that also took up the issues of unemployment and crisis, in addition to the one of health care. There were assemblies against redundancies and the rise of living costs in which the temp workers participated together with workers of the Tiburina industrial zone, where workers had been made redundant (Voxson, Fiorentini). There were also neighbourhood committees taking part who strengthened, at this point, the struggle for the reduction of rents, and, above all, workers who had been dismissed from a private clinic (Villa Domelia). The latter provided a precious contribution to the struggle in the health sector, as their struggle targets a private boss who had dismissed 33 workers (the “exploiter Serra, who has amassed in his hands, with the blood of the workers, a strong capitalist nucleus that comprises 13 private clinics and companies manufacturing hospital materials, with the help of all kinds of speculations that you can imagine.”) [29] Their struggle allowed to highlight the close link between the private and the public health sector (in cases in which the private clinics made agreements with public hospitals in order to provide health care for proletarians) and the way that both workers and patients were treated.
The workers of the Villa Domelia confirmed that “they won’t give in to this maneuver of the boss, because the defense of their jobs also means an attack on an inhuman and classist health system”, observing that “in these private clinics, where patients are transferred on subcontracts, the exploitation of the proletarians can be organised easier, because there are no instruments to prevent that or to defend oneself.” [30]
Even the hospital council participated in this assembly, the representative structure of the hospital workers who opposed the move by the bosses to transform the entire Policlinico into a teaching hospital. This was an important sign of the new situation that was emerging amongst the hospital workers. Imposing the struggle of the precarious workers according to the goal of unity amongst workers and an alliance with the popular masses, they achieved that also the ‘stable’ hospital workers adhered to these goals, who, up to that point, had rather taken care of the defense of their own position than of the general interest of the popular masses.
After a dramatic episode, when a young temp worker of 22 years of age threatened to throw himself out of the window of the pediatric clinic after having been dismissed, the hospital council intervened in favour of the struggle of the temp workers and confirmed that the temp contracts were illegitimate and that the administration is responsible regarding the need for health care provisions for the patients: “The hospital council denounces such situations, in the name of all hospital workers who daily experience the bigger and smaller dramas of working in a hospital and university clinic, and who know how insecure, discriminatory and sometimes indecent the conditions of service provided by the university workers are.”
For all these motives, the correctness of the struggle of the temp workers is related to the attitude of the trade union leaders: “[The hospital council] considers it justified to call on the trade union leaders in this sector to finally raise their voices in defence of university workers, and to ensure that their actions are commensurate with the duties that these trade unions are required to fulfil.” [31]
These independent positions of the hospital council, initially inspired by the unity of care workers for the proletarian self-management of the hospital and against the barons, had a large following in the assembly, but were repressed by the higher-up ranks of the trade union. This led to the fact that the council would once more retreat into positions that distinguished ‘professional categories’. In the meantime, the struggle of the temp workers weakened and the rector managed to get through with his maneuver of hiring only 60 temp workers and dismissing the remaining. Also the hiring process of the ‘fortunate ones’ happened with a lot of irregularities, and without taking into account the struggle that preceded it. This is a lesson, also for the Collective, which subsequently confronted the clientele and old-boys-network character of the hiring process (which is related to the problem of the ‘moralisation’ of the hospital, according to which recruitment happens under irregular contracts, which later on would somehow be corrected). In a document the Collective stated: “we demanded from the administration to make public the ranking which it applies when any kind of recruitment is going on, These rankings should take into account: first those who have worked for three months and passed the hiring process, then those who only worked the three months, then those who only passed the hiring process.” [34]
New trade union disputes – the autonomous organisation advances
The way that the ‘overtime compensation’ had been implemented, and the acceptance by the trade union of that implementation, left a lot of discontent amongst the workers. At the same time the numbers and strength of those who demanded a transferral to the regional health board grew with the struggle of the precarious workers. They saw this transferral as the only measure that not only created unity on an economic plane, but also on the level of the work organisation within the hospital.
So, in a moment in which the trade union is absolutely absent (coincidentally in the summer season, when the barons go on holiday and the patients are shunted from one place to the other, mainly to the overflowing pavilions of the university clinic, and the whole organisation of the hospital falls apart), the university and hospital workers decided to struggle together around a series of objectives, which could not be solved on the level of trade union negotiations: here we talk about the increase in the number of staff “which have to be figured out in department assemblies, held together with the patients”; the minimisation of harmful working conditions through the reduction of working time and the elimination of working overtime; the job tasks “which should be defined department by department”; wages in relation to the actual living costs and “stabilised at the level which directly corresponds to the life necessities”; reduction in the number of professional categories, with “wage bands exceeding professional boundaries, creating only three categories with a single parameter, subject to periodic increases based on seniority”; and finally the unification of all university clinics through the absorption of all workers (for example, the non-medical staff) by the hospital unit. [35]
This commitment to fight, which demonstrated how the clinic workers (who were called ‘hot heads’ or ‘students’ by the SUNPU, given the fact that some members of the Collective were former students) had been successful in creating an autonomous mobilization which went beyond their specific category, was responded to by a joint intervention by the trade unions SUNPU and FLO, in order to reestablish order. The FLO called for strikes based on a platform different from the one that was decided by the hospital council, in order to limit the agitation of the hospital workers to a single issue of outstanding wages. [36] SUNPU, on the other hand, returned to the attack with economic demands, jumping on the new bandwagon of bringing clinic workers back into the dispute over the civil service contract, which is supposed to establish an all-inclusive salary (i.e., fully pensionable) to equalise all civil service pay; although the platform of the trade union contains demands for the equalisation of wages of people who do the same jobs, it would also increase the pay difference between lower and higher wage categories. Regarding the Policlinico, according to their platform the directors would even earn more and the care staff less! [37] For all these reasons workers didn’t show much enthusiasm for the dispute and continued to organise themselves independently. This is why SUNPU started to use openly repressive methods “making arrangements with the office supervisor so that they would use all their power to prevent [the workers] from leaving their work place” (19th of October 1972).
One might wonder how trade unionists can end up like this, but if you think about the approach of SUNPU and other public sector unions, you will see that their ‘inappropriateness’ in their confrontation with the workers who they are supposed to ‘represent’ (to use the words of the hospital council) is the other side of the coin of their ‘responsibility’ towards the general problems of the state (of which the hospital is a part). This leads them towards the pure and simple repression of workers, in accordance with the state bureaucracy, in the name of the ‘general interests’, in the struggle against the wasters and against the absenteeism (in spite of the real interests of the patients, of those who don’t receive care etc.). [38] At this point also the bureaucratism, which entrenches itself within the legal system, says that “the regionalisation cannot be done”, “you would need a law” etc., even though there is already such a law and it would be enough to interpret it correctly.
The collective explains this well when they identify the trade union as a bureaucratic instrument that the government needs, “now that the union of the state employees is directly joined up through a proposed agreement with the government, whose main point is to guarantee the ‘dear friends’ from the unions a seat at the table during the planning phase of restructuring of the state administration.” (19th of February 1973) The collective criticised the demand platform of the unions and their lack of interest in the needs and the will of the workers, which expressed itself in the fact that more and more workers attended the assemblies, and said: “this fact proves the absolute necessity to push towards rank-and-file organisations […] let’s organise them without leaders and all-powerful fathers, but with the will and conviction of the correctness of our demands, in order to come to a clash with the bosses and their serfs, whether they are trade unionists, middle-managers or supervisors, because they will always be our enemies” (5th of November 1972)
In a period where the clash between the line of the union and that of the collective becomes more open, the need to reinforce the will of the workers, and to overcome their subordination also in political terms, becomes paramount. The collective managed to raise this sensitive issue by using heavier language when addressing the workers themselves: “up to now the workers at the university know only how to lament about the heavy work conditions or the wages that are inadequate when looking at the increase in living costs etc. – but they do this without understanding that apart from management, the responsibility for this situation lies also with us. We accept this attitude, which makes us look like fools. We let ourselves be blackmailed, bow to orders, we do everything to obtain our special allowances (20,000 lire per year) which only the State Council recognises as our right”. (20th of November 1972) They remind the indecisive and disillusioned amongst the workers that neither the shift to a different trade union [39], nor the change of the secretariat of the SUNPU [40], nor new delegates will change our conditions.
Meanwhile the autonomous struggle of workers started to prove its efficiency. A mobilisation for a payment that the contract workers were entitled to, but that had not been paid by management, was organised independently by the collective and obtained the desired result. The same happened regarding the recognition of 15 days of statutory leave. [42]
It became clear that with an independent mobilisation of workers, the aims of the transfer to the regional hospital contract could be achieved. During the course of the assemblies, where those comrades were nominated who later on became ‘points of reference’, the organisation of the Collective grew clinic by clinic. In this way, “without delegating our interests to anyone” (which affirms the new position that “the Collective is not a trade union”), people organised themselves in order to maintain links between the various hospital sectors, “to guarantee a real power in the confrontation with management, the barons and the rector, imposing on them that they deal with us workers directly when it comes to our issues” and “to be able to do without the ‘union cover’ that we pay for by the abandonment of our goals and struggles and by accepting the will of the bosses”. [43] This form of organisation allows to contest the labour relations in each location, the ‘exploitation’ of the patients for medical research purposes, the crazy conditions under which ‘care’ is given; to beat the power of the barons in its various articulations.
But there is something more. The Collective realised that the rank-and-file mobilisation can be transformed into a force that allows them to negotiate directly with those in power. The relation with the various institutions (rector, regional administration, ministry) and the structures which mediate the popular will (parties, trade unions) was problematised for the first time, which would find its original solutions a year later during the negotiations with the regional administration. The Collective didn’t concede anything to the ‘realistic’ theories of those who criticised the workers’ autonomy, saying that “there is always a need for negotiations” and that the Collective would be incapable of playing that role. Instead the Collective was able to develop from that moment on the right dialectic between ‘popular power’ which constituted itself in the clinics and a tenacious struggle, also on the legislative and administrative level in order to reduce the power of the monopolistic state bourgeoisie. [44]
For now, the organisation of the struggle clinic per clinic served more modestly to make workers aware of how the dispute over the compensatory allowance for the public sector workers is finished from above, in a way that is beyond the control of the workers. “After long negotiations, changes of government, farcical strikes etc., the trade unions and La Malfa (politicians) have managed to agree to ‘solve once and for all’ our issues. Regarding the workers with a public sector contract a pensionable allowance has been agreed that amounts to 515.000 Lire per year for a porter and 518.000 Lire for a nurse, for a head secretary 1.240.000 Lire. Who profits from all this? Of course the higher qualified job categories.” (17th of August 1973) [45]
The hope for unity between the workers in social services, which the trade unions reduced to a dispute over equal pay for public sector workers (according to them it was a first step towards the health reform), served to reinforce the super-burocratic line of the government. In fact, this pay platform, which aimed at the differentiation of wages by granting lower increases to the lower job categories and higher to the upper level categories, went well together with the policies of the government for the ‘superburocrats’: to secure “capable and expert” functionaries for the state by paying them wages equal to what the private sector pays. If we look at the consequences of this policy for the health sector, where the public and private sector are closely linked, we can see that this form of competition only strengthens the strata of barons, who rule over both sectors and who are the major voters for the DC (Christian Democrats). It is them who wanted this ‘reforming’ law. The most absurd thing is that the trade unions are talking about a “victory for workers”, welcoming the “new model of development” and the fight “against parasitism”, just because these incentives might mean that some scientists or senior technicians remain in the public sector, thereby slightly improving the quality of public services.
The struggle for free health service and against private hospital beds
During the course of the struggle for the allowances, while the trade union proceeded with their inconclusive negotiations, the Collective put into practice what they had already discussed as “a project against the exploitation through private hospital beds and for free health services”, meaning, the picketing of the outpatients department to enforce that they operate free of charge.
With this action the Collective hit the main source which the barons used to enrich themselves (the private beds provided an income for the clinics over which the barons had full disgression). [46] The issue of private beds is the clearest expression of the discrimination between rich and poor patients. The rich patients are well cared for in the private beds “with the money of the workers” (22nd of February 1973) [47] and the poor patients are facing long waiting times during the few hours per day when the outpatients department is opened. On top of that they are made fools of, as they have to pay for these outpatient services, despite all contributions that they pay into social insurance (meaning, they pay double!). The Collective wrote: “On top of exploiting us in the factories, where they also make us sick, the bosses then make us pay for the outpatient services and discriminate between proletarian and upper-class patients, offering comfortable private beds to the latter and the cesspool of the crowded admission halls for the latter.” (18th of November 1973) [48]
Let’s have a closer look at the functioning of the outpatient departments. Before the workers had raised the issue of the outpatients, “in most areas of the university clinic the usual rights and entitlements of the health insurance system were not recognised, as the ‘scientists’ [doctors of the university clinic] were not willing to lower themselves to the level of simple doctors of the public outpatient services” (8th of February 1974). In this way the outpatient visits were not reimbursed by the health insurance and the workers who came to the university clinic had to pay themselves. In this way, management tried to differentiate between a visit at the university hospital and a visit at a normal clinic, wanting to make believe that it was something special, something better and more accurate, first of all through a higher level of science. On the other hand, the low cost of the visits (in general around 2,000 to 3,000 Lire, but, as we will see, with considerable exceptions) acted as a lure, so that there was always a large influx of people.
In reality, the outpatient departments of the university clinic are the channels through which the transfers of patients between the public and the private sector is regulated, according to the interests of the barons, the directors of the university hospital who are at the same time the directors and co-owners of the private clinics with their own outpatient departments. The way in which the public outpatient departments work, with their ordeal of long waiting times and having to draw numbers in order to be seen during the short opening times, is the prime incentive for throwing oneself into the welcoming arms of the private health sector. In fact, one of the other demands of the Collective was the extension of daily opening times. This would be very easy to accomplish, given the large number of doctors in the university clinics, and would break the chain of profits that are made from this system. “The doctors who own private clinics are afraid of losing their hefty profits that they make from the outpatient visits, if here at the university hospital and other clinics the outpatient departments were free of charge and open all day” (22nd of October 1974). Actually, the barons earn from the hospital visits (through the dividends from the clinics) and even more when the exasperated patients ask to be received, often out of spontaneous decisions, at the private clinics, thereby subjecting themselves to considerable sacrifice at the moment where they see no other way to be cured. [49]
Another common way to transfer patients to private clinics is based on the agreements with the health insurances. There are certain expensive medical examinations for which you have to pay at the university clinic, but for which you are reimbursed by the health insurance if you have them done at private hospitals. This is how it comes that the baron tells the patient “just come to my clinic, which is registered with your health insurance, so you just have to bring your insurance card and you pay nothing (and I still make a profit!)”.
The outpatients departments of the university clinic deliver another precious commodity: those patients who are found to be in need of hospitalisation. Some patients (those who can become guinea pigs for the research, or who are ‘of interest’ for the teaching department) are hospitalised within the university clinic, but most of them are diverted to the private clinics, with the excuse that there are no free beds or that all beds are booked. They are promised that in this way they can get treatment by a professor. (Sometimes people give this advice to go to private clinics when they face the inefficiency of the public hospital. Often staff give this advice out of precise economic interests: the possibility to work overtime).
We can see that there are many obvious reasons for putting the outpatient clinics at the centre of the struggle for health and to turn them into spaces of encounters between health workers and those proletarians who use the hospital.
The struggle was meticulously prepared and was preceded by a far-reaching “engagement with the public opinion”. One Sunday in February 1973, the workers spoke to patients and relatives who came to fetch them and explained their motivation for taking action. They wanted to find out if others are willing to join and to secure support and participation. The reasons are complex, but they can be summed up as follows:
The relatives and patients at the university clinic can become aware of how the hospital functions and how to struggle against the profiteering of the barons.
The proletarian patients have already paid once for ‘this type of service’, for which they are now supposed to pay again: this is an injustice which needs to be fought against directly. To refuse to pay for the medical examinations in the outpatient departments is a way to “refuse to pay for the damages received from work, based on exploitation” (16th of February 1973). It is therefore a struggle for health from a “workers’perspective”, according to which “the struggle for health means to fight against exploitation – for absenteeism, for sane housing conditions, for free services, for a guaranteed wage” (19th of February 1973).
It is, in consequence, a form of struggle for the reappropriation of the produced wealth, like the struggle against inflation, for rent reduction or the reduction of energy bills etc.
All this is very clear for the sick proletarians and it sounds very different from the discourse that is usually heard within the care sector: “there is so much talk about medical assistance for workers and proletarians, they destine millions of Lire of workers’ taxes for the improvement of the infrastructure, they announce a health reform of the employers, but up to now they have not come clear about all these things”, said the Collective. Therefore “the proletarians who come on a Sunday to find their ill relatives in the ghettos of the wards have received our proposal with enthusiasm, as it responds to their actual needs” (19th of February 1973)
The significance of this action was also explained to other interested groups. To the students the Collective said that the struggle “is part of the unification with the needs of workers, for organising themselves together with the workers and to destroy the division between students and workers which is functional to capital; this attacks the power of the barons, the repressive anti-worker force within the faculty” (16th of February 1973)
Given that the proposal clearly targeted the barons, there would not have been a need for so many explanations to the university workers, if it hadn’t been the case that some trade union ‘bureaucrats’ jostled their way in by saying that without the income from the outpatient departments (which constituted the infamous ‘la mora’ / ‘bonus’) the workers will lose out. The Collective responded by saying that this was false, as the workers wage “was determined by a law (article 1042)” and that even “if this wage doesn’t respond to the needs of the workers”, it doesn’t make them dependent on the ‘bonus’; [51] on the other hand, the trade union tried in this way to involve the workers in the interests of the barons (“the income from the private hospital beds and the outpatients only end up in the pockets of the barons”, 22nd of February 1973) [52] In order to avoid any confusion created by base speculations about the “material” interests of the workers (who, according to this logic, shouldn’t give a toss about the interests, also material, of the ill proletarians), the Collective repeated that “not a penny will be lost for workers wages”. (22nd of February 1973)
On the basis of this preparation, the occupations of the outpatient departments started by pickets of workers and proletarians who came for examinations. The first occupations were at the ‘ear, nose and throat’ (“where the mafia baron Filipo ruled”) and the pediatric department (“which was run by baron Cassano, closely tied to the Christ-Democrats / DC”) . [53] These departments have been chosen wisely! Here, for several days, despite the intimidation by the barons and the threat of police intervention, proletarians from the neighbourhoods of south Rome and their children were examined free of charge under the direct control of the workers. This demonstrated clearly and in practice that initiatives of this kind can open a dialogue between hospital and territory for a workers’ management of the hospital. “The comrades related immediately to the proletarians and those workers who came for examinations or accompanied their children […] It is necessary that all workers of the university clinic are present in this struggle, which affects them directly and leads them towards a workers’ management of the hospital. It is necessary that the factory workers and the workers from the neighbourhood contribute to concretise this goal. Only in this way can they become part of an organised structure which aims at the worker leadership of the struggle, the only form of organisation that relates to the totality of needs of the entire working class” (22nd of February 1973)
The response of the barons is immediate: they call the police to defend the “law”, meaning, “the privilege of those who exploit us, make us sick and fatten themselves on our blood”, and thereby reveal their “humanitarian” spirit and their interest in the patients. At first, “facing the will of the proletarians to see things through, the police and the doctors backed off” and the police retreated into a different part of the hospital, leaving the struggle to continue. They followed the suggestion to delay things, which had also been given by the trade unionist Iembo, (21st of May 1973) [54] but not “without first having stopped and noted down the names of everyone who protested against this disgusting form of health care and this system of exploitation” (22nd of February 1973). Later on, after two weeks of struggle, the barons retook the control over the outpatient departments. “The barons have been hit in their interests: in terms of money and in terms of the myth of a medicine that pretends to care for the poor as much as for the rich. They have responded in the only possible way: with the police, which transformed the hospital into barracks, intimidating and striking the workers and proletarians in struggle”. [55] The fear that popular rebellion, if properly channelled towards the right objectives, could make the slogans of the Collective truly effective, led the barons to have the Polyclinic guarded “to make sure that the work of the doctors and the peace and quiet of the patients is not disturbed”!
Still, even though the mobilisation ended, the barons were not able to resume their domineering attitude as before. First of all, as a result of this struggle, the private hospital beds were abolished. Secondly, there is an extension of agreements regarding health insurances, and in certain cases, when workers impose themselves, it is possible to make sure that patients don’t have to pay, even without a picket. (But here the question of the daily control over the functioning of the hospital is raised, and the need for the workers and patients to conquer the power to lead the hospital: the barons will never decide to run the outpatient departments free of charge, it will depend on the strength of workers to impose it). [56]
Furthermore, the struggle opened the eyes of many regarding the interests that the medical establishment serves. “The majority of doctors have confirmed once more their anti-worker stance and have demonstrated clearly that the science acts in the interest of the bosses, as an instrument of the exploitation of all workers. […] When the police arrives, the doctor who remains neutral becomes an assassin”. (22nd of February 1973)
Commenting on the results of the struggle, the Collective affirms: “By now we have understood that the reason for our illnesses is the exploitation; that we become sick because of the piece-rate system, the infernal work rhythms, the poisonous materials with which we have to work and the unhealthy housing conditions, and that in order to not become sick we have to struggle against this exploitation and against capitalist work […] We want that the hospital is really at the service of all workers. By now we have understood the plan of the bosses and we have experienced it on our own skin: with the suspensions, the dismissals, the being sent on the dole, the arrests, the denouncements. They want to force us to work more, for less money and in silence, in order to restructure and increase their power […] We refuse to fatten up those doctors who collaborate with the bosses to control the absenteeism and to turn the hospital into an assembly line…”
During these mobilisations “the proletarians have demonstrated their capacity to be the political leadership of this struggle”. They have managed to mobilise vast sectors around an issue that concerns directly the control of monopolistic capital over the popular masses; they have also shown that with suitable forms of struggles it is possible to force important social infrastructures like hospitals to function in adequate ways for the needs of workers.This depends both on the strength of workers to put fear in doctors who, if they didn’t have police protection, were forced to consult patients free of charge and the capacity of workers, who know very well how to run outpatient departments in the interest of proletarians.
Footnotes
[9] In order to keep their hold over these workers the barons pay much higher wages for those hours worked in the private clinics (for which they don’t pay social security)
[10] The text alludes to the proposals which were put forward by the union during this period, not to improvements that have actually been gained.
[11] There are also specific moments of struggle against the overtime, largely decided in the assemblies of the clinics, which rebelled against the particularly untenable conditions of understaffing and abuse by the administration. For example, on the 28th of November 1972, the workers of the maternity clinic united in an assembly “and decided to stop working overtime, because overtime aggravates the problem of unemployment and divides the workers. They condemned the exploitation that continued within the clinics and which allowed the administration to act arbitrarily, often not even paying for the overtime already worked or for bank holiday bonuses”. (29th of November 1972)
[12] The reference to the health reform is only an alibi for the trade union in order to maintain that the transfer to the regional health sector is deemed ‘non feasible’. But for the trade union, even the disputes about the quality of care or the power of the barons is ‘not feasible’. According to the union, In order to make the health reform ‘feasible’ these issues cannot be touched. This in fact happened with the law no.386 from the 7th of August 1974, which addressed the debts of the insurances, and with the design of the law about the national health service, which left both the power of the barons and the monopolistic interests untouched which tied the public health system to the private one.
[13] The law 1042 says: “Three years after the coming into effect of the law of the university reform, the university and the institutions of university education have the right, in addition to the cases permitted by general law, to make permanent appointments from their respective budgets to carry out the duties of non-teaching staff in connection with proven operational needs and the increase in teaching, research and student population. Assignments […] may not exceed the limit of 30% of the corresponding posts.” Obviously, the application of this law would always maintain the status as state employees of the paramedical staff and would not create a unity with the hospital employees. Nevertheless, this law was not put into effect in order to avoid burdening the treasury with additional recruitments!
[14] This was confirmed by a legal decision from 1972, which the workers often quoted in their leaflets.
[15] In a different leaflet about the concluded dispute (3rd of July 1972) the Collective says even more clearly “that practically the trade union asks that the university workers are paid with the money of other workers who have become sick, while the barons and the administration fatten themselves undisturbed on the backs of both […] We have to say no to all of this, we have to demand the abolition of patient fees. Our wages should be increased by diminishing the profits of the administration and bosses and not of the skin of other exploited workers like us”.
[16] “And by now it’s clear to everyone how much of a failure the so-called equalisation payment has been: one one hand it does not unite us with our colleagues who have a hospital contract, on the other hand it leaves the legal division and the difference in the base rates unaltered; it divides the rest of the university staff which is forced to fight absolute rearguard and lost struggles (for the increment of bonuses, not of the base rate)” (5th of June 1972)
[17] See also the open letter to the trade unions written by Ottavio Verdone, from prison in Rebibbia, where he was locked up for more than two months in winter 1975 (leaflet of the 4th of February 1975)
[18] The ‘invoicers’ were workers who were hired for a particular labour and paid by funds from the clinic; this is a contractual relation that doesn’t exist anymore, since the passing of the De Maria law, which centralised the funding. The ‘scholarship holders’ are workers with a scholarship to study. The subcontracted workers are hired for a limited amount of time; they are hired by the university and paid with funds allocated to individual institutes.
[19] All quotations referring to the subcontracted workers were taken from the leaflet of the struggle committee from the 23rd of April 1972.
[20] 8th of August 1972, leaflet signed by the assembly of temp workers
[21] The council of the hospital, supporting the struggle of the temps, expressed itself as follows: “The temporary contracts are only sanctioned by the existing law for seasonal activities, but becomes illegal and fraudulent once it compensates for permanent and progressive lack of staff, even if more severe during the holiday season” (27th of September 1972)
[22] 24th of August 1972, leaflet of the agitation committee of the temps
[23] 24th of August 1972, leaflet of the agitation committee of the temps
[24] 1st of September 1972, leaflet of the agitation committee of the temps
[25] The temp workers touch upon a problem that concerns all workers, hired through various contractual relations, who, in order to enter the job or move up the pay scale, always have to prove anew that they know how to do things that they actually have been doing for a long time.
[26] Document that was accepted unanimously by the assembly of temp workers, 1st of September 1972
[27] 6th of September 1972, leaflet of the agitation committee of the temps
[28] 16th of September 1972, leaflet of the agitation committee of the temps
[29] 20th of September 1972, leaflet signed by the committees of the temps and the struggle committee of workers at Villa Domelia
[30] 20th of September 1972, quoted. The “patients on subcontracts” are patients who were transferred from the hospitals to the private clinics. In the leaflet from the 22nd of September 1972 the committee of the workers of Villa Domelia said that by taking over also the pavilions of the hospital and by turning it all into a university clinic, management would obtain the result of “allowing the private clinics to increase their profits and allowing even private clinics that lack any hygiene or health standards to take over these beds, thereby creating an actual market of patients.”
[31] 27th of September 1972, Leaflet of the hospital council
[32] In a leaflet by the Collective from summer 1973 they speak about the fact that the ‘Paese Sera’ mentioned 110 newly hired and flaunted them as a victory by the trade union. The Collective, in contrast, maintained: “us workers know very well that the 110 new recruits are no others than the porters (not nurses) who were successful in the hiring process in March 1973, plus 40 disabled recruits”.
[34] Organisational proposal for the workers in clinics and university institutions of the Policlinico, by the Collective, June 1973, page 6
[35] 21st of July 1972, leaflet of the assembly of hospital workers
[36] After a few months, the hospital workers understood the maneuver of the FLO and reverted back to the unitary platform. They elected a rank-and-file committee to replace the hospital council, which the top management had deprived of any ability to represent the demands of the workers. The leaflet from the 3rd of February 1973, signed by Stramazzi, Angelini, Bagagli, confirmed: “The rank-and-file committee, which is composed of 11 workers who have been elected amongst all hospital workers, has the task to lead the struggle for this program politically, against any impositions by management which aim at weakening this struggle.”
[37] “Such a platform fundamentally favours the higher up managers and doesn’t alleviate the chronic inequalities amongst the university workforce in the least (workers and employees would lose out on 300.000 Lire a year)” (16th of October 1973). Earning a minimum of 1.250.000 Lire, the printers would lose parts of their salary that had been granted on the basis of Law 1042.
[38] It is necessary to add that this responsibility also has its advantages, because given such a ‘sensitivity’ no one [of the trade unionists] will deny themselves the pleasure of turning a blind eye if someone is skimming off the top, using the hospital for their own business, or taking home steak from the kitchen. As part of the struggle against the political line of the trade union, the Committee of workers and students at the Policlinico has always highlighted the aspects of corruption that were related to the union’s complicity with the university administration. In the first leaflet of the collective they denounced parts of the ANPO, the association of the university barons, which “engages in plotting, fearing that the delegates will prevent them from exercising their excessive power” and the unions CISL and UIL “which want to leave the clientelism and corruption on which they are based untouched” and they give concrete examples for this clientelism: the labour inspector Molinari (CISL) which writes down overtime for himself which he hasn’t actually worked and who “permits other individuals to engage in illicit activities during working hours, inside the hospital. For example, Mr Pellegrini, a former fascist, member of the CISL, who deals with golden jewelry which he has bought on auctions, he sells trousers and shirts, he lends money at high interest rates; Mr Di Spirito, also member of the CISL, sells meat and sweets at work; Mr Fiorini, former member of the CISL and the works commission, fears that the council of delegates will stop him to work as a ‘technician’ in a peripheral laboratory, which had been established on his suggestion, for which he doesn’t have the required qualification” (11th of May 1971)
[39] First of all the UIL tried to benefit from the disillusionment of the workers with the activists of the CGIL, presenting itself as the trade union of change.
[40] In April 1973 the SUNPU had its annual congress, from which a new secretariat emerged, which quickly resumed the same kind of politics: negotiations about the contracts of the public sector workers and monetarisation of (health) risks.
[41] This deals with the application of article 2 of the law 1042
[42] The assembly of porters and nurses in the imaging department affirmed on the 20th of February 1973 to have received a confirmation from Giannotti (managing director) for “1) 15 days of holidays, paid at base rate; 2) recognition of job tasks; 3) payment for risks. It is clear that the workers are not willing to sell their health or to only struggle for the minimum. Meanwhile they claim a right that they are entitled to by labour law, even if this is faulty and at the service of the bosses. Then they will struggle beyond the confinement of job categories for wider solutions of their problems through regionalisation and a program of attack on the exploitative nature of capitalist labour”.
[43] Quoted from ‘Proposals for Organisation’
[44] 28th of June 1973: “We accept the proposal of those regional representatives who have undertaken to present a bill to implement, including through bureaucratic channels, our just demands. But we want to remind you that without a rank-and-file organisation, without a real struggle of workers, it is impossible to achieve our goals.”
[45] Later on this the agreement was called a “‘rubbish contract’ for the public sector workers that eliminates all benefits beyond the basic pay, paying only a few thousand Lire through the allowance” (27th of September 1973)
[46] This reminds us of the struggle of the workers against the ‘incentives’, which was a refusal of being complicit in the way that the barons ‘used’ the patients. The struggle against private hospital beds is a continuation of that struggle.
[47] The private beds cost 30,000 Lire in advance and then 25 to 30,000 Lire per day, excluding medical exams and tests.
[48] From this stems the slogan of the day: “let’s put the barons in the cesspool”.
[49] Normally the patients transfer themselves to the private clinic, but sometimes this is directly initiated by the outpatient department of the university clinic, on request of a doctor who receives a standard fee. The patient – intimidated by the gods in white and the difficult and often deliberately incomprehensible jargon – doesn’t dare to oppose this, led by the entire system to believe that they are privileged if they have managed to get a visit.
[50] For example, a brain scan, which is by now a common examination requested by doctors to detect brain injuries, costs 40,000 Lire.
[51] According to the law, the bonus can be substituted by a different non-pensionable enhancement.
[52] The dividends from the clinics are distributed according to arbitrary criteria, which leaves only crumbs for the workers. But there are also paternalistic barons who use the dividends to remain in the good books of the workers.
[53] Leaflet without date, distributed in March 1973
[54] Iembo was the secretary of the FLO during this time
[55] Same leaflet as quoted in footnote 53
[56] The problem also arises in terms of effectively abolishing clinical profiteering. What were previously private rooms, with one or two beds, should now be used for more serious cases. In order to prevent that the director can still put his friends and private clients into these beds (even if it means for these friends to pay an undue bribe, as seems to still be the case in the dermatology clinic) and to send those who really need them there, it is of course necessary that workers are in control of the clinic.
