During the last week of April I participated as a delegate of my Unison branch of a local NHS Trust in this annual meeting that brings together all Unison reps in the private and public health sector. This year, I reckon around 400 to 500 delegates met in Liverpool, average age around 55, mainly white, half of the delegates were women. What could have been a great opportunity of collective working class reflection on changes at work and experiences of struggle turned out to be a pretty tedious series of largely meaningless motions. Nearly all motions limited themselves to moaning about how bad things are, followed by general appeals, rather than concrete proposals. For example:
“Conference therefore calls on the Service Group Executive to: 1. Continue to raise concerns about the impact of pressures within services on staff mental health, calling on employers to provide adequate support.”
People, and often the same people, used these motions to make speeches about how tired everyone is and that everything is the Tories’ fault. The motion would then pass unanimously. It felt like these speeches were mainly used for individuals to be seen and heard, perhaps for future elections. There were only a few snippets of interesting information during the speeches e.g. concerning a recent strike vote at Manchester Community Health against restructuring, which got a 98% endorsement, or that the control room for ambulances in Dorset has a 40% annual staff turnover.
The only contested motion, and the only motion that would have at least a symbolic consequence, was put forward by the Northern Ireland delegation. These guys seemed pretty militant, at least they had some strike experience in the sector recently. They demanded that Unison stop giving evidence to the Pay Review Body, given that they are just a fig leaf for the government. The Pay Review Body (PRB) is meant to give impartial advice to the government about how much the pay increase for NHS workers should be. For more than a decade they’ve more or less suggested the imposition of real wage cuts.
Their motion was scheduled as number 8. Motion number 7 was put forward by the Executive Committee, which said that Unison should continue to demand a flat-rate, rather than percentage increase, which benefits BME, women, low paid workers – and that Unison should continue to work with the PRB. So if motion 7 would pass, motion 8 would be out the window. There were the usual speeches to bolster the Executive Committee’s motion number 7: we have to be inclusive, support the lowest paid workers etc., which was a cynical move to use ‘minority workers’ to defend the status quo with regards to the PRB affiliation. But at least it came to a card vote on the issue. Around 200,000 votes voted against, versus around 160,000 in favour of motion number 7, meaning that the motion passed, and the conference would have no consequence whatsoever.
On the second day, the head of the union for health workers in Ukraine spoke, representing 600,000 members. She mainly spoke in patriotic terms (“the Ukrainian people”, heroic efforts of the country etc.) and said that their union supports the armed forces financially. The Unison general secretary mentioned that 10 ambulances were sent from London to Ukraine, with medical supplies, otherwise the general discourse was not questioned: the UK has to support the Ukrainian army, they are fighting for Europe and democracy. Not a word about the larger and systemic context of the war or about the class contradiction within Ukraine. A motion from Manchester to speak on the ‘Stop the War Coalition’ march was folded – the SWP lot would probably have used the motion to speak against ‘Nato and imperialism’.
The rep from Barts Health Trust claimed that the taking in-house of over 1,400 Serco staff was mainly due to ‘negotiations’, and that negotiations are better than strike – he denounced the ‘strike’ by Unite workers at the Trust as ineffective. The most interesting dispute seems to have happened at Princess Alexandra Hospital around the outsourcing of domestics: 200 members were involved, meeting in church halls, they collected 8,000 signatures in town etc. These workers seemed much more self-organised. There was not much time for questions. Only a short intervention by a member of the Homerton branch regarding the outsourcing and Living Wage campaign of 350 staff.
The Trust ended up having to pay £16 million in total. The main HCA activist, an Eastern European woman, was pretty impressive, though at the end of the session there was little space to ask questions, such as: what about the pay loss due to less Sunday/Night-Shift bonus on Band 3; what about people saying that on Band 2 they can choose whether to do clinical tasks or not, according to how stressed they are on the day; what about HCAs often doing clinical tasks only occasionally in order to help out stressed nurses; what about the danger of deepening divisions between HCAs and porters, domestics, housekeepers, if a pay increase is attached to ‘specific tasks’ etc.
Of course I am not the only one who thought that there were a lot of missed chances in a meeting that brought so many delegates under one roof. But then we cannot underestimate the fact that many of these delegates are pretty happy with a ‘cushy’ conference and are perhaps not the most militant workers wherever they work. Still, there many reps are genuinely interested in building rank-and-file workers’ power. Some SWP and Socialist Alliance people (perhaps also other ‘rank-and-file’ oriented people) set up a slate for left-wing Service Group Executive Committee candidates and distributed a leaflet, inviting people to a meeting in the evening. At least the leaflet made some valid points about why the pay campaign in 2021 failed, e.g. that Unison was preoccupied with the difference in claims of other unions, rather than working together – and that they forced people through two indicative ballots.
There were only about 20 people at their meeting, mainly politicos, I think. They spoke primarily against the mean bureaucracy and then four candidates for their slate-made speeches. Unsurprisingly, their main focus is on the change of the Unison apparatus, though they all seem also pretty involved on the branch level. In a way, this small fringe meeting was another missed chance, as we didn’t really hear self-critical reflections of organising attempts, their limits, difficulties, problems and how people tried to overcome them. The problem is that in the framework and tussle over of a large institution with large funds, everyone wants to portray themselves as successful and victorious, which prevents a sharp analysis of the struggles of our class.
We handed out 60 – 70 copies of our own Health Workers’ Newsletter (I should have brought more), but people had to march through Socialist Workers and Morning Star lines, so they were perhaps less interested in yet another paper. At least one positive feedback. I think if people actually had a look at the newsletter, they would have been interested, as it provides some more interesting thoughts and info, e.g. on the weak points of the pay campaign 2021, and the recent strikes in Germany, which addressed the staffing question in an offensive manner. If you work in health and are up for supporting the self-organisation of workers’ struggle in the sector, get in touch:
Last year’s pay campaign failed – This year we have to find our own ways to fight for more money and less stress at work!
Last year all major unions within the NHS balloted their members on the 3% pay ‘increase’ offered by the government. While most voted to reject it, none of the unions managed to get more than a quarter of their members to even vote, so the campaign died.
With the cost of living exploding, we’re facing another year with an effective pay cut. People didn’t think their pay was sufficient. So why didn’t they participate in the pay campaign? Here are some thoughts.
* It wasn’t Covid that did it…
Some people (and quite a few union representatives) blamed the pandemic, saying that we shouldn’t engage in public protests or industrial action for better pay, because we’d lose ‘public support’. That seems bullshit to us. Health workers in Germany, USA and France took action and received substantial support – see report from Berlin below. We shouldn’t have to justify ourselves, but we can: if we don’t fight for better wages and less stress at work, then even more workers will leave the NHS. The crisis of the health system is not caused by workers’ struggle, but by underfunding and workers leaving the jobs. Despite their Brexit plans, the government has to recruit more care workers from abroad, as over 40,000 people have left the care sector during the last six months. The new workers will have to be paid at least £20,500 a year – which is more than any Band 2 care worker in the NHS who has been in the job for years. That’s how desperate they are.
* We can’t just blame the unions…
It’s true, the trade unions did little on the ground. At least in the hospitals and communities where we work (around four, five different Trusts) there were hardly any meetings, protests or public actions. The union apparatus relied on sending people emails or text messages – which just won’t cut it. But the question we have to ask is: why did we, the workers, rely on them and not do it ourselves? We should have pushed for general assemblies in each hospital or NHS community organisation, open to all staff groups, disregarding union membership. In the current atmosphere, such assemblies might only attract two, three dozen colleagues out of the hundreds, if not thousands of people who work for a Trust. But even a relatively small meeting would at least allow us to really discuss what we want to change and what we can do to mobilise our colleagues. We have to start somewhere…
* We need more money for sure, but stress is the main issue…
A problem with the campaign was that it focused only on the wage question – while the main issue for many of us is that we go home exhausted and stressed. If we had actual gatherings of workers, the demand for better pay would have come up, but we would probably have combined the pay demand with a demand for better staffing levels or more control by workers themselves about who does what and how. At the moment, everything at work is decided top down, which causes stress and depression.
* We have to discuss what it means to go on strike in a hospital…
Having said that Covid might be more of an excuse for not doing anything, many colleagues sincerely worry about the impact that ‘a strike’ would have on patients. That is a real issue, we don’t work in car factories or in an Amazon warehouse! One flaw of the last pay campaign was that there was no real discussion about what ‘industrial action’ could mean in the health sector. We can’t expect union officials to solve this problem for us, as it is us who know which parts of our daily work actually save the lives of patients and which parts are less urgent or just exist in order to satisfy management and pen-pushers. We will need some collective analysis and creativity to find the best ways to put pressure on management and politicians.
* We have to learn from health workers who actually fought back…
As soon as they see that wards are understaffed, organised nurses in Australia ‘close beds’ themselves and it is management’s job to get extra staff. In Austria, ambulance drivers went on a ‘paper strike’ and didn’t fill out any paperwork that was mainly there to allow management to claim money back from health insurance companies. In Greece, health workers and patients formed common assemblies and organised actions to defend local community health services – see article in this newsletter. In Germany, nurses went on strike and enforced minimum staffing levels – management had to make sure that emergency cover was organised. In the US, nurses on strike organised their own emergency cover when they saw that their strike action actually posed a risk to patient lives – beyond temporary discomfort. In Argentina, health workers blocked access roads to oil fields and tourist resorts, to cut off financial supply for the government. There are many ways to take industrial action that don’t ‘harm the patients’…
* Wages are not (mainly) decided by the government…
Both management and unions will emphasise that ‘wages are decided on the national level’ and that, therefore, any demand or action that comes from a group of local workers is useless. That’s not true. We know that individual Trusts can pay extra money to attract or retain certain groups of workers. We know that Trusts pay more for bank shifts if they need people. We know that although the law said that after Brexit there won’t be ‘free movement of labour’, the government will undermine their own laws once people are needed in care or agriculture – it just depends on pressure and a balance of power.
* Don’t wait! Do something when and where you can – and tell others about it…
The conclusion that the trade unions draw from the failure of the campaign is to say: let’s mobilise for the pay campaign in 2022. This is not good enough. We have to take action ourselves wherever we can. On each ward or community surgery we can get together and change things. There are dozens of small examples of groups of workers taking action, from health care apprentices who criticise the way the apprenticeship is a cover up for ‘cheap labour’ to hospital security guards who take action for proper sick pay. We don’t have to wait for the next ‘official campaign’ to do something – but we should tell other workers about what we did and coordinate future actions in a bigger circle beyond department or Trust boundaries.
* Even when it’s hard, make an effort to create a friendly community with your colleagues
We are all stressed, many people start the job and leave again, we often work with bank or agency staff who we might not see again. All this makes it really difficult to create friendships and solidarity at work, but we have to try. Otherwise we will continue blaming each other for being stressed, rather than pushing for better conditions together. So let’s keep on being kind and interested in new people, let’s support each other!
At the moment a lot of workers in other industries are pushing for higher wages – from truck and bin drivers to baggage handlers. There is a shortage of workers. During Covid, workers showed that they know how to keep safe and keep things running, even when managers don’t have a clue. We also saw that a lot of jobs are not socially relevant. They are a waste of time and energy. Some scrabble to find part-time jobs, while others are forced to work overtime till they drop. All of this shows that we, workers who keep things ticking over, should take back control over how work is organised. Needs and joy before profits!
We are an independent circle of workers in the NHS and the wider health sector. We want to learn from struggles in the past and present and support each other. If you are interested in what we are doing, get in touch: firstname.lastname@example.org
The ‘Berlin Hospital Movement’ and the strike in Autumn 2021
The following two articles about the hospital strikes in Berlin in the Summer and Autumn of 2021 are exciting. The first text paints a wider background picture, while the second article contains more subjective and personal elements. We can see what people can do if everyone gets involved. We shouldn’t forget, though, that we need more than just ‘success stories’, as beautiful as it is to read that workers can actually win! We translated some bits of news articles below and we asked fellow health workers from Germany what they think about the strike and its outcome.
*** Playing hardball: An account of the Berlin Hospital Movement
The ‘Berlin Hospital Movement’ has made history. For several weeks, the employees of the two large municipal hospitals, Charité and Vivantes, went on strike together with workers at the privatised Vivantes subsidiaries. Taking industrial action for better working conditions, they were able to build on many years of organising efforts – and, after nights of tough negotiations, they finally got their collective ‘relief’ agreement (which refers to better staffing levels).
What factors contributed to this victory?
Until recently, nobody believed that nurses could go on strike – a hospital isn’t a factory and patients can’t be abandoned like a production line and health and care staff have a moral responsibility for their patients!
In this movement, workers from different professional groups and with different outsourced employers were fighting together. Demands have been for collective agreements that cover all workers regardless of profession or employer, and include stipulations about staffing levels, compensation for high workloads, better quality training and a general collective wage agreement.
These demands were made in response to inconsistent applications of minimum staffing levels across hospital sites, nursing shortages, and reforms proposed by Germany’s governing coalition that were seen as lip service to grievances rather than constituting any real improvements.
The movement took 10 months to organise the strike; by May 2021 there were 500 active members of the Berlin Hospital Movement, and a majority (8,400) of workers at both hospitals had signed up to the demands and agreed to strike action. The majority petition is one of the tools in labour disputes that US organiser Jane McAlevey refers to as a stress test.
Organising was based on the McAlevey approach of ‘building real power over the long term’ She learnt how to organise by those who were taught by organisers from the radical unions of the 1930s. *They took a strategic approach; going through the factories floor by floor, office by office, department by department, until the last one was convinced, until there was maximum participation in the strikes.”
‘Berlin Hospital Movement’ activists followed this approach: ward by ward, the ‘Hospital Movement’ activists organised and the majority petition was the test of strength, which showed both the employer and the workers: ‘You are not alone, we are a majority that is ready to fight and also to strike.’ Another tool is the organised one-to-one conversations. Wetzel, one of the worker activists, explains: “We have been able to make a concrete offer to our colleagues so that they can channel their anger and turn it into something productive. We can fight together and have a plan. Many colleagues are angry. For them the ‘Berlin hospital movement’ came at just the right time.” Organising and concrete options for action offer a way out of the frustration of everyday life and enable them to confront politicians with strength and concrete demands. “Taking it into your own hands,” is how Wetzel describes this approach. “We have set up structures in eleven hospitals that are capable of going on strike and are assertive, across the occupational groups, from registered nurses, trainees and to colleagues who work in the lab.”
“Since we started organising a year ago, 2,200 colleagues have newly joined the union. This means that, after wanting to avoid disputes and look for reform without active participation of members, Ver.di has little other option but to embrace these new methods.”
Support also came from outside: the union-affiliated agency ‘Organiz.ing’ specialises in the methods that bear its name, designs special campaigns and has already assisted the fighting hospital workers in telephone campaigns and large-scale mobilisations.
Investments in Berlin’s municipal hospitals were agreed upon by the state’s coalition government in 2016. Support for health workers’ concerns has grown enormously since the beginning of the corona crisis and the media have reported more often than ever on the grievances in the health and care sector. The timing of the 100-day ultimatum by the ‘Hospital Movement’ to the politicians was also strategically well chosen to put pressure on the state government by coinciding with the election of the Berlin House of Representatives.
After the deadline for the ultimatum had passed and following a warning strike at the end of August 2021, Ver.di initiated a ballot for an indefinite strike. On the 6th September 2021, the union announced that 97.85% of unionised workers at Charité had voted in favour of strike; at Vivantes it was 98.45% and 98.82% at the subsidiaries. On the 9th September 2021, the ‘Berlin Hospital Movement’ went on strike. One month later, on the 9th October 2021, they demonstrated through Berlin with several thousand supporters under the slogan, “We’ll save you – Who’ll save us?” They were joined by the Gorillas delivery service couriers who were also on strike and by activists of “Expropriate Deutsche Wohnen and Co.” who had just won the Berlin-wide referendum to bring large private housing companies into public ownership.
Despite all these positive preconditions, the struggles were nevertheless hard and long. This is not only due to stubborn management or the failure of individual politicians, but above all because of the logic of ‘economisation’ of the health care system – which increases the burden on health workers and results in poor care. On average, a nurse in German hospitals has to care for 10.3 patients. This puts the German healthcare system at the bottom of the league. The main reason for this understaffing issue is the so-called ‘flat rate system’ by which hospitals are paid for providing treatments, which means that, given their tight budgets, they can only make a profit if the treatment is delivered with as little labour input as possible. Management tends to save money by reducing nursing staff and outsourcing service employees to privatised subsidiaries.
Outsourcing, reduced duty rosters and flat-rate per-case payments are the direct consequences of the ‘economisation’ of healthcare. With the triumph of neoliberalism, flat-rate payments were introduced in the mid-1990s, accompanied by considerable job cuts in the health sector. Between 1997 and 2007, 48,000 jobs were cut, that is 15% of the total nursing staff in hospitals. Other areas such as cleaning, kitchens, patient transport and laundries were outsourced and privatised. In addition, when calculating the flat-rates, only the consultants’ work is taken into account, with nursing work not included. So their work is usually not ‘revenue-relevant’. Since at least 2008, hospital employees have been fighting against this austerity policy, which is disguised as a practical constraint to which there is no alternative. Back then, 130,000 hospital workers and their supporters demonstrated against the austerity measures and for better working conditions, and they presented the then Minister of Health with 185,000 signatures. From 2010 onwards, the Ver.di shop stewards’ group at the Charité hospital in Berlin began to place the focus more strongly on staffing levels as a central demand in the collective agreement, while at the same time developing the concept of the ‘Bed and Ward Closure’ strike.
In 2011 the workers went on strike for the first time: For five days, large parts of the Charité were out on strike, meaning that 90% of operations had to be cancelled, and Charité suffered financial losses. “Everything that can be postponed or that we can cancel, will be shut down. Emergencies are still being taken care of, but the rest of the hospital operations are shut down,” explains Wetzel. The union notified management in advance of beds and wards that will be unoccupied or have to remain vacant or be closed due to the strike. “The responsibility then lies with management. Hospital employees thus have leverage to strike, without the moral pressure that they are abandoning their patients, that many of us feel.” At the same time, they hit hospital management where it hurts.
The ‘Collective Relief’ Agreement
The first ‘collective relief agreement’ was fought for in 2015 by the employees of the Charité; prior to that, there had been an eleven-day strike on 20 wards and 1,000 beds. The collective agreement was intended to give hospital employees tools to counter the excessive workload and staff shortage. “This collective bargaining agreement was a milestone because it made the demand for more staff and relief collectively negotiable,” Wetzel reports. In fact, the collective agreement became a blueprint for other collective agreements of this kind in clinics throughout Germany. The current agreement in Berlin builds on the collective agreements of the Jena and Mainz University Hospitals which were forged in 2019 and 2020. Wetzel: “If the shifts are not appropriately staffed, workers accumulate bonus points. When they reach a certain amount of points, they are given an extra day off in the coming working week. However, they can also have the amount paid out or deposited in a working time account.” The ‘Collective Agreement Relief’ is a model to objectify performance pressure and individual stress as collectively as possible, thus preventing both individual burnout and the individualised micro-struggles between employees and works councils which represent them.
One key to this is the personnel assessment rule. But how many staff is actually enough? And which personnel, what kind of groups of workers? It is as relevant to break down specific illnesses according to the intensity of care they require, as it is to take the level of training or qualification of the employees into account. The employees therefore demanded that they should be the ones to determine staffing levels. Up to this point, detailed recording of work steps and processes has been a means for companies to increase profits, rather than to relieve workers. After more than a month of strike action, first the management of the Charité, then that of Vivantes caved in.
Just one stage in the process of struggle
Wetzel already has the bigger fight in mind: “We are now in contact with many hospitals to continue the fight for relief elsewhere, but we will also continue our fight against economisation in hospitals in general.” Despite the bitter aftertaste that staff in the subsidiary companies will still have to continue the strike, the almost year-long struggle of the ‘Berlin Hospital Movement’ plays a focal role for others: If Charité and Vivantes have to hire thousands of new nurses, not only will their working conditions improve, but the competing hospitals will also have to react. The ‘hospital movement’ has also shown how one can organise power against economic pressure and privatisation. In Berlin, a labour struggle against austerity was waged and won. The consequences of this will be seen not only in other hospitals, but in many labour struggles to come.
Two weeks after the strike: Camilla is sitting in front of me, she has been a nurse in the operating room for 38 years and a Ver.di member for 30 years. Today she has a cold. The tension of the strike is easing and she is clearly relieved. During our conversation, her eyes kept wandering to the other side of the road, where she and her colleagues stood at the picket line on some of the 34 days. After being hesitant at the beginning of the campaign, Camilla actively joined the movement in July and even took over the strike leadership on some days. She was one of the people who had to decide which colleagues could go on strike and which had to do emergency work. Through a so-called emergency service agreement, the striking nurses ensured that patients were not put at risk. The way it works is that the workers in the individual wards announce in advance how many beds will be on strike. This gives the hospital management the chance to prepare and not admit any new patients. If too many emergencies come in, the strikers make sure to come back on duty. The hospital management did not agree to this tried and tested model, so the strikers unilaterally made sure that the emergency service would be staffed.
Camilla points to the picket line and tells me how colleagues from all over the hospital met and got to know each other there. Many who had worked in the same hospital for years talked there for the first time. The strike included almost all professional groups, from nursing to the laboratory to cleaning. Today, people greet each other during breaks, on the way to work or after work. We know each other in the hospital now, says Camilla. Where previously there were lone fighters, a solidarity has emerged that goes beyond one’s own team or professional group.
DEMOCRACY BEGINS ON THE WARD
Louisa is 24 years old and studies clinical nursing alongside her work at the Charité. For a long time she wanted to become politically active, to fight grievances, but she never dared to do it alone. When the various professional groups at the Charité, Vivantes and the Vivantes subsidiaries came together to form the Berlin hospital movement, she found the courage to do so. It takes a certain amount of self-confidence to be able to stand up for yourself and your colleagues, she says – and this comes about step by step. In the course of the industrial action, she joined the ver.di trade union. She started to inspire her colleagues for the movement and was eventually elected team delegate for her ward. Each ward where the majority of colleagues were involved in the collective bargaining process could elect delegates. They represented their ward at the Berlin-wide meetings, supported and advised the collective bargaining commission. The team delegates also passed on the most important information to their team. News usually came in thick and fast during the strike.
BUILDING POWER THROUGH A MAJORITY PETITION
How do you manage to build such a structure? Only through good preparatory work. In order to motivate colleagues to put forward their demands and elect delegates, they must first learn about the industrial action and be convinced that it makes sense. A petition that rallies the majority of workers behind common goals is a good way to do this. Collecting signatures is a good way to start a conversation and practice convincing the majority in each team. Supported by organisers from ver.di, the colleagues collected signatures for two months – for a collective agreement on better staffing levels and (at Vivantes) for the return of the subsidiaries to the TVöD [public sector collective contract]. Active employees held talks ward by ward, noted down their successes and planned who they still had to speak to.
When more than 8,397 signatures were handed over to the Berlin state politicians and the clinic management on May 12…the hospital movement entered the capital’s political stage for the first time. When the signatures were handed over, the ruling parties were given a 100-day ultimatum: either they accept the demands of the health workers and put pressure on the hospital management at the state’s own hospitals – or there will be strikes during the hot election campaign time. This was a threat. Despite countless expressions of understanding, the politicians let the 100 days pass without doing anything, so that it actually came to a showdown…
COME TOGETHER, NETWORK, DECIDE
One of the most important meetings was the Berlin Hospital Council, where all the delegates from the individual wards met in July to discuss the hospital movement’s common demands. It was not only the clear majority with which the results were accepted that was spectacular, but above all the setting: in the “Alte Försterei”, the stadium of the Union Berlin football club, over a thousand colleagues and supporters filled the main stand – a highlight that made the attendees aware of their own strength.
EVERYONE HAS TO GET INVOLVED
Louisa describes that the second phase of the campaign, coming up with the demands, woke many of the colleagues up. The many intensive individual discussions (“1 to 1s”) were the key to success. “It was fascinating to see how someone reacts when they are given the platform to speak freely about grievances. The attitude ‘care for others, but remain silent about your own needs’ is something learned. I also learned that in my apprenticeship: it’s better to say nothing and compensate for everything. As a result, we no longer even notice what is going wrong. We can hardly imagine an everyday life in which one does not go home stressed.” In the many discussions, it became clear to the workers that they are the experts who know best how good care actually needs to be organised.
FIERCE RESISTANCE, PERMANENT PRESSURE
The persistent political pressure that the colleagues organised in the company, and carried into local politics again and again – was central to the success at the negotiating table. Franziska Giffey (of the SPD political party) could hardly attend an election campaign event without being besieged by the Berlin hospital movement. When Raed Saleh, chairman of the SPD parliamentary group in the Berlin House of Representatives, was planning a beer garden tour, there were no tame SPD sympathisers at the beer tables, but a dozen nurses. “We got on the politician’s nerves,” Diana says, “this presence was important”. The workers took their concerns to the city and received broad support: almost 5,000 Berliners followed the call to demonstrate “We’ll save you – Who’ll save us?”, the Volksbühne opens its doors for a press conference and the alliance Gesundheit statt Profite [Health instead of Profits] collected several thousand euros for the strike fund for the Vivantes subsidiaries, which would not have been able to hold out as long without this support. Care became one of the central campaign issues. In training courses, employees learn to tell their stories and make everyday life in the hospital visible: at demonstrations, in the Berlin evening show, in the Berlin election campaign arena. The impressive stories and the fear of overcrowded intensive care units in the pandemic did not allow the SPD, the Greens or the left to openly criticise or dissuade the movement. Who wants bad press in the summer of the election campaign?
WE NEGOTIATE OURSELVES
The backbone of the trade union movement was the hundreds of union volunteers who organised themselves ward by ward. For Camilla it is clear that at this point union work has to be rethought: in the collective bargaining struggle, “Ver.di has to mobilise everyone, otherwise the union movement is a bird without wings”. Democratisation means that the important decisions in a collective bargaining dispute are made by the workers themselves. And this works: whenever the full-time negotiators from Ver.di and the collective bargaining commission negotiated with the employers, the team delegates met at the same time. This could take up to 30 hours at a stretch if the commission negotiated for that long. All decisions of the collective bargaining commission were fed back to the collective decisions of the delegates.
With the team delegates, the collective bargaining commission had a body of experts behind it that could directly counter any objection from the employer. This made it possible to counter the employers and even expose them, as they did not know the individual areas as well as the workers themselves.
The Berlin experience has made it clear that trade union organisation is not an end in itself. It requires work, strength and energy. And it can really change something substantially.
*** A few comments on the health workers’ strikes in Germany
All of us workers need to be inspired and get some positive vibes, but we also have to learn from the weaknesses of previous struggles. Here are a few critical observations concerning the strikes in Berlin:
* Ver.di managed to attract 2,200 new members during the run up to the strike and many people became so-called ‘team representatives’ or delegates. But it seems that the mobilisation relied heavily on around 40 paid organisers who went from ward to ward to get the ball rolling. The question, as usual, is what will happen once these organisers are withdrawn. Will the structures and relationships that developed between workers during the campaign be strong enough to sustain the momentum?
* To a certain degree, the strike relied on emergency cover that had been agreed with the employer. In previous disputes, the union would announce with a week’s notice how many workers would go on strike on what ward and management would make sure that either beds are closed or extra staff sent to the respective ward. During the Charite strike, management didn’t agree to this arrangement. Instead the ‘minimum staffing level’ during the strike was calculated on lower night-shift or weekend staffing levels. The union would nevertheless give one week’s notice, which gave management time to reshuffle workers and find cover for those wards and beds that were affected. If wards were severely understaffed, management would contact the strike leadership and they would ‘send people in’. This was not really discussed at the level of the rank-and-file strikers, but decided between hospital and strike management. The union didn’t counteract management’s reshuffle of staff – the union could have mobilised workers from the subsidiary companies (cleaners, porters etc.) in those areas, but that doesn’t seem to have happened.
* At the Charite hospital there are about 100 wards and only two wards were completely closed due to the strike. This demonstrates that, despite many workers participating in the strike, the actual impact was rather marginal. The union itself says that around 10% of all nurses took part in the strike. Many workers joined the pickets on their day off and signed the strike list for that day, which means that the actual strike participation might be below 10%.
* The strike lasted for over four weeks, which must have surprised management. This might have been the limit though, as workers started to feel the financial pinch, despite union strike money and collection from strike supporters. The workers of the subsidiaries, who are less well paid, started to face difficulties first.
* Many reports emphasise that the strong point of the strike was that permanent staff of two different hospitals and the outsourced workers went on strike together. This is only partly true, as workers of the subsidiary Charite Facility Management (CFM), who had gone on strike on their own during the previous year were not able to join the recent strike due to the length of the agreed contract (“Friedenspflicht”, no industrial action during the duration of the contract). They remained outside of the movement despite vocal discontent with the way that the negotiated agreement was implemented, e.g. the wage categories.
* The outcome of the strike is largely positive, but there are also weak points. Some of the agreed staffing levels still seem precarious, e.g. a staffing level of 1:17 for nurses on night-shift on ‘low intensity care’ wards (somatic wards) seems still pretty heavy. Management also tried to include as many ‘auxiliary’ workers (healthcare assistants, housekeepers) into the general staffing ratio, which would water it down. This might aggravate the ‘professionalism’ of the registered nurses and deepen divisions (“We are more qualified, we should not have to make beds.” “Auxiliary tasks should not be included in the staffing ratio” etc.).
* Due to staff shortages it is likely that management will pay the agreed bonus payments for understaffed shifts, rather than actually provide more staff. These bonus payments are lower than some of the previously paid ‘extra shifts’ (so-called ‘Joker-shifts), that were used to cover staff shortages. Nurses were paid up to 50 Euros p/h basic wage (plus 50 Euros p/h for weekends and 50 Euros p/h night-shift bonus) for these shifts, compared to the usual basic rate of 21 to 26 Euros. The bonus payment will be paid to a bigger group of workers, but the agreement has created certain divisions, as people who used to take on a lot of ‘Joker shifts’ feel that they have lost out.
* Another dividing factor is that ‘non-registered’ staff (e.g. health care assistants) only get ⅓ of the ‘bonus points’ for working on understaffed shifts compared to ‘registered nurses’. Initial demands by registered nurses were that only registered nurses are taken into account when it comes to establishing staffing levels. This kind of makes sense, as management tries to include other staff, such as healthcare assistants, and thereby ‘waters down’ the official staffing level – as healthcare assistants are not trained to do all jobs. In the end, management agreed to the registered nurses demands, which means that they are not obliged to include the healthcare assistants into the financial compensation scheme for understaffed shifts. To pay them only ⅓, although everyone knows that understaffing impacts everyone on the ward, is a fudge.
* Despite the fact that ‘essential workers’ went on strike during a pandemic, something that should grab peoples’ attention, the ins and outs of the dispute were not very well-known or much discussed amongst health workers outside of Berlin. Shortly after the strike in Berlin, health workers in various towns took industrial action for a pay increase as part of the public sector collective contract. Unfortunately Ver.di agreed to an increase below the current inflation level.
A report from health workers in Greece
We are two pharmacists from Athens. During the pandemic, the state and bosses used the ‘state of emergency’ to criminalise any voice against their official COVID rhetoric. They made us into, “soldiers in the war on coronavirus”. And like soldiers, we had to obey or get punished at work. In this oppressive atmosphere, it became even more apparent that we had to organise, and rather than simply obeying like soldiers and heroes, we had to start struggling as workers.
In hospitals, the power of managers and supervisors over both us and patients increased tenfold. Every day we got told which patient will get the respirator, who will go into intensive care, who will live and who will die. We had no say. All this was happening without PPE, in rooms thick with viral load. We saw workers from whole departments get sick or even die from the virus. We saw them reprimanded because they caught the virus. It isn’t a coincidence that Greece is one of the top countries of health worker COVID cases inside hospitals.
There was no place for sick leave or our normal (already overstretched) working hours in a time of ‘war’. We got used to constant night shifts and overnight work. Our annual leave got cancelled – and remains so. They worked us to the extreme, sending us to man COVID clinics with zero experience or training. All the while, pharmacies were making massive profits as they hiked up their prices.
During these hard months, two polar narratives appeared: On one side, the “truth” of bosses and the state talking about heroes in white coats. And on the other side, our own, the truth of workers on the frontline, confronting a ruined, chronically understaffed, unsafe national healthcare system. A system ruled by managers and their snitches, who, through fines, layoffs and the police, tried to drown any voice that attempted to reveal what we were actually going through.
Despite all the different contracts and divisions amongst the workforce, some struggles did take place but were few and far between and low-scale. But we did manage to form grassroots, local neighbourhood assemblies, bringing together health workers working in local primary healthcare centres and healthcare users/patients. These assemblies organised protests and opened up local struggles. One assembly in Athens managed to get the local authority to hire people in a primary healthcare centre instead of shutting it down.
Organisation from below
An Athenian assembly – called ‘Movements for Class Autonomy’ – organised a Campaign for Universal Healthcare, which raised the issue of health in public speeches and spaces. Various Athenian assemblies joined it (neighbourhood, worker, political groups) from various factions of the Greek movement (anarchists, leftists, and autonomists). Campaign assembly meetings had the authority to make their own decisions, which gave the campaign flexibility and speed to react to the ever-changing social context. We collectively wrote a manifesto on public health, opened new struggles and supported existing ones in the sector. We met with other healthcare workers from various assemblies or on their own. We wrote leaflets and distributed them to other healthcare workers in hospitals, primary healthcare centres and their users in various neighbourhoods in Athens. We organised rallies in front of hospitals, the Ministry of Health and health centres.
So what should the content of our struggles be, and, ideally, what kind of health system do we actually want? In general, we want a system focusing on providing a healthy life for workers instead of sticking a plaster on them when they get sick so that the ruling class can squeeze the workforce a bit longer. We want local health centres in every neighbourhood .
The make-up of these common assemblies would mean we could share medical knowledge that is currently clenched tightly in doctors’ hands. That would enable patients to make their own, informed decisions about their treatment and their body. They would also have the power to make decisions about local healthcare units, for example, to demand the hiring of a dentist as private ones are too expensive.
Outsourced security guards at Great Ormond Street Hospital have also just started their six week strike, despite a court ban on noisy pickets outside the hospital, which they are currently challenging. In terms of their work contracts these workers are in a weaker position than most NHS workers, but they show that together we can struggle for better conditions – even during a pandemic!
We translated this article from the German magazine ‘JungleWorld’ for the general debate…
Left politics, which claims to represent a democratic perspective that goes beyond capitalism, cannot be satisfied with the goal of merely redistributing the social wealth generated under capitalist conditions. It must at least strive to liberate labour from the form of wage labour and thus from its coercive character, to pose the question of property as one of capital relations, and to put an end to the violent dynamics of capitalist compulsion to accumulate. For the inequality that necessarily characterises capitalist class societies stands in principle contradiction to a conception of democracy as the form of a society of equals and free people, in which production must be self-determined, free of domination and thus must be democratically organized.
With the example of health care, one quickly learns to bid farewell to simple notions of emancipation.
It is easy to formulate in such abstract terms. But what does that mean for the health care system? This can be discussed using the hospital sector as an example. Until the mid-1980s, hospitals in the German Bundesrepublik were not organized in an entirely capitalist way, due to a legal ban on profits and to the way they were financed. That has changed thoroughly since then. More recently, since the red-green federal government introduced the system of flat rates-per-case in 2004 and expanded market mechanisms, hospitals have been fully subjected to capitalist operation. This applies to both privatised hospitals and those that continue to be in public or not-for-profit ownership, for example, those run by church organizations. Just how dysfunctional it is to organise the hospital sector in this way, is evident to any contemporaries who are not completely narrow minded, in the Covid 19 pandemic.
The reform proposals for this sector can be used to illustrate what the difference is between a social-democratic and a left-wing but intra-capitalist policy, and to sketch out what a left-wing policy that points beyond capitalism and aims at a self-organization of society might look like.
Almost all [German] parties except the Linkspartei [Left Party] hold essentially liberal economic positions on the hospital sector. Although they now want to improve the financing of hospitals’ maintenance costs, they want to centralise the sector and privatise it further. They hardly express any doubts about market mechanisms.
The SPD at least claims to have recognised that the so-called economisation of the hospital sector is a problem. However, it does not mention that it was itself involved in the profit-oriented restructuring of this sector. Their concrete proposals consist of making small corrections, but not changing the fundamental mechanisms.
The SPD’s election program for the 2021 federal election states: “Profits generated from funds of the solidarity community must flow back into the health care system, at least for the majority.” The system of flat rates per case will be “put to the test, the flat rates will be revised and, where necessary, abolished”. Of course, “where necessary” does not mean Germany, but individual specialties, such as paediatrics or obstetrics.
Similar positions can be found in the Green Party’s Bundestag election program: “The common good orientation in the healthcare system should be strengthened and the trend toward privatization reversed. The concentration on profitable services must come to an end. In the future, hospitals should therefore be financed not only according to case numbers, but also according to their social mission.”
For employees and patients, this would be entirely desirable. In view of the interests of the healthcare companies operating in Germany, however, it is questionable whether the cautiously formulated will to somewhat contain the capitalist constitution of the healthcare system will be sufficient to achieve this. There seems to be no desire to take on the real opponent, the capital factions that want to invest and make profits in the healthcare system in this country. The coalition agreement between the SPD, the Greens and the FDP confirms this assumption.
The Left Party takes a left-wing parliamentary position in its Bundestag election program: it is wrong that hospitals should be run on a profit-oriented basis. Private hospitals and nursing homes should be transferred to public ownership. They would have to be organized according to need and public welfare. We want to replace the system of flat rates per case with needs-based financing. “We want to replace two-tier medicine with a solidarity-based health insurance system into which everyone pays.”
Of course, this would not abolish capitalism, but at least capitalist mechanisms would be explicitly excluded from the hospital sector again and private ownership would be transferred back to common ownership – which could open up possibilities for further considerations. The fundamental distributional questions are posed in health insurance: A solidarity-based citizens’ insurance system should include all incomes and income types equally. All this would be possible and make sense. At least with regard to patent protection for Covid-19 vaccines, an internationalist perspective is also made clear in the program: “The pandemic in particular shows that pharmaceutical research is a public good. The licenses for the Corona vaccines must be released.”
But what would a left perspective on health care that points beyond capitalist conditions be? What demands would result from this with regard to ownership in the hospital sector? Should private hospitals, for example, be handed back to the municipalities, or should they be organized as cooperatives? How should medical needs be determined and who should plan to meet them? Should a central body be responsible for planning, or should it be democratised by involving employees, patients and local politicians? In which bodies could this be done? How should the mediation between these and a central planning body, which is unlikely to be dispensed with, take place? In short, how does one democratically determine the need for medical care?
The assumption that this need would simply result from the sum of individual needs and demands, and that everyone could therefore get what they need, ignores possible supply problems, because it is a matter of what is medically necessary. In the disputes and strikes in the hospitals, employees and political activists ask themselves such questions: Which services in the hospital merely serve profit, and which are medically justified? The former can be dispensed with.
Practical experience gained during strikes in the hospital sector could also be linked to a transformational perspective: Strikers in hospitals now often no longer allow union representatives to conduct collective bargaining alone, but each ward or team delegates one person to participate in the negotiations. These units of action of self-organization have been experienced by many strikers as collective self-empowerment.
In the example of health care, one quickly learns to abandon simple notions of emancipation. A radical left perspective cannot assume that in a society that no longer produces in a capitalist mode, everyone can do what they want. Even under communism, people will have to work day and night in health care, and this highly complex work will have to be planned and organized. The question of which services are to be provided by society will also arise. Not everything that is technically possible will be socially useful. Here, too, it cannot be assumed that everyone will get everything they want. We can therefore look forward to conflict-ridden democratic disputes between equals and free people.
Marx describes this freedom as the “realm of necessity”. It can “only consist in the socialised man, the associated producers, who rationally regulate their metabolism with nature, bringing it under their communal control instead of being dominated by it as by a blind power; carrying it out with the least expenditure of force and under the conditions most worthy and adequate to their human nature.” This also applies to health care.
The main healthcare unions have spent the last 6 weeks consulting their members on the 3% pay ‘rise’, which has now trickled into some workers’ September wage slip. While members who did vote overwhelmingly rejected the offer, across the board, turnout was very low – too low in all but some GMB Southern Region trusts to win a mandate for industrial action legally.
This was predictable. Even though staff are pissed off, they are not being spurred into self-activity, nor even actively demanding the union does something. Getting a higher turnout would have required an all- guns-blazing strategy of mobilisation from the unions, and there seemed to be only a few firecrackers going off!
From a Unite healthcare worker:
“Unite’s ‘Day of Action’ in August was a damp squib – we got one email a week beforehand asking us to organise a hospital protest but no reps responded. When I tried to push it with the regional officer, I was referred to the main rep who was on holiday. Other Unite members in other parts of the country were told it was more of an ‘online event’. Unite used an online balloting system, supposedly for the first time, meaning you had to wait for an email to appear from them in your inbox before you could click on a link to vote. When I didn’t receive mine, I had to chase up, and was told that because I didn’t tick on a certain mailing preference box when I signed up, the ballot email wasn’t sent out to me. The whole thing meant that if I didn’t have an active and proactive interest in knowing what was going on and wanting to vote, the whole thing would have slipped me by…”
From a Unison healthcare worker:
“At our branch we relied primarily on emailing and texting individual members to mobilise them to a ‘drop-in’ in a tent in the hospital car park. Not many people attended, perhaps a dozen on each of the three drop-in dates, out of a total workforce of nearly 9,000 and a Unison membership of over 2,000. Even perks like £5 canteen vouchers weren’t enough to get the punters in! Proposals to organise a joint-union protest rally in front of the hospital were rejected. It seemed that the RCN had the same problems at their stalls at a different, and remote corner of the hospital.”
From an RCN healthcare worker:
“…members’ events I’ve been to have been encouraging – nurses rallying outside hospitals. It was cool to see RCN and Unite nurses/members coming together for these. Some have also involved local lobby groups. Official union events have been more often organised with and for workers at specific trusts. So closed meetings inside hospitals, out of public view – with stalls set up for visiting heads (including reps from local government) to speak with members and answer questions – this put me off.
At (online) meetings I’ve found contributions from nurses involved in past actions helpful – particularly members who got involved with the Northern Ireland strikes in 2019. More recently there’s been celebration of voter turnout and response, stoking momentum – but to read/hear that members have “voted overwhelmingly against” 3% feels hard to reconcile with the 25% turnout, and how things feel at work. I’ve shared campaign materials where I’m based (in a community mental health team) and uptake has been supportive, but limited. There’s only a couple of nurses in the team active with a union, and only half the team are employed by the NHS (half work for the council/local authority) – so as yet, the pay campaign hasn’t felt the most shared, relevant thing we’ve had going on.
RCN have been less vocal than other unions about joined-up actions, but I think this could really help. Now unionised council-employed workers are beginning to ballot too, I’m hoping this leads to more discussions and ideas about ways we can support each other across the sectors”.
So what happens next? Only GMB is going ahead with a proper industrial ballot at this point. Despite not meeting the thresholds that would be needed to actually go on strike, all of the rest of the unions (aside from RCM) are pushing ahead with an indicative ballot for industrial action. This involves asking their members if they want to actually take industrial action – even though some of them already captured that data in their first ballot (Unison, Unite), or despite the fact that they could have asked in their first ballot (RCN). While unions might think they need all these ballots to ‘build momentum’, the more likely result is to lose it…And if we go on the efforts of their last ballot ‘engagement strategy’, there is nothing to indicate more people will vote this time round…
This article from a NHS trade unionist spells out why successful industrial action is unlikely under the current arrangements. Basically, in order to enforce a pay rise, we would need more coordinated action across the unions, which would mean common demands amongst a divided workforce – divisions that are perpetuated by the unions who are only interested in ‘their’ members. So where does that leave the huge anger amongst workers about the measly 3%?
Unite, with their new General Secretary, are making noises about ‘coordinated and targeted actions’ within the NHS. This is an attempt to ‘work with what’s there’ – which, in a workforce as divided as the NHS, seems like a pragmatic step forward, unlike the Royal College of Midwives, who seem to have given up the ghost entirely. We need real worker engagement – which will only happen if the unions are able to relinquish some control, for the full-timers to not worry about pissing off senior NHS managers, and foster a strategy towards worker self-activity that means that we can directly affect our work on a day-to-day level.
% reject pay offer
% industrial action
12.5% pay increase for all nursing staff covered by Agenda for Change terms
Indicative ballot announced to see if nurses are prepared to work to rule or go on strike in protest at the government’s “completely unacceptable” offer.
12.5% pay increase for all nursing staff covered by Agenda for Change terms
Launching indicative ballot 12/10/21 to ask what, if any, type of industrial action they’d be willing to take over pay, after members rejected the 4% pay increase offered.
Unspecified – just “not enough”
Consultation with UNISON branches on whether they think they can get enough members to vote. An indicative industrial action ballot to ask whether you are willing to take industrial action. If a minimum of 45% of all members take part – and the majority say they want to take action – we can move on to a formal ballot.
£3,000 a year or 15%, whichever is greater for all health sector workers
“Plan for a comprehensive programme of targeted industrial action in the coming months”
GMB Southern region
15% minimum pay increase or an extra £2 an hour whichever is the greatest, Unsocial hours enhancements to be paid to all staff when on sick leave; Commitment that NHS pay will never fall below a Real Living Wage again.
Over 50% in certain key trusts
Moving towards a formal strike ballot
Not specified: “Relatively low turnout”
Choosing instead to focus on next year’s pay review
Pay rise? What pay rise?!
People have largely now been given the backdated ‘pay rise’, but many complain that they actually have less in their pocket. After inflation, a planned National Insurance increase, and rising energy bills, the 3% quickly disappears and we’re in a situation where we’re actually paying out more than before!
“My job role is a Clinical Specialist (Nurse)’ at AfC band 6. After tax, NI and pension contributions, the 3% raise amounts to about £50 more a month in take-home pay.”
“I’m a full time band 2 NHS housekeeper with one year’s experience and no student loan. I took home £1,256.4 per month last year, which has gone up to £1,285.03 this year – so an increase of £28.63 a month or about 2.3%.”
“…my pension rate was put up to the next band, which based on my new basic pay, would be incorrect and that’s taken pretty much all my back pay. This had all meant that my take home pay last month was roughly £200 less than normally is. A lot of my colleagues have had a similar thing happen…”
“I’m a band 2 housekeeper, I was on a ‘training wage’ i.e. for new starters before they get their care certificate, being paid 75% of my regular wage. I was expecting the 3% increase because I am a permanent NHS worker, doing the job as it’s supposed to be done, but didn’t get it. I rang up HR and they gave me some bull about how I wasn’t entitled to it…”
* Bristol – Wages of arbitrariness
While so far the pay campaign has been fairly tame at our Trust wage divisions within the Trust start to surface. As a result of the national dispute about whether unsocial hour bonuses should be included into pay for annual leave or not it became apparent that workers’ conditions are very different within the same Trust, depending on where people work. In some departments and amongst some professional groups, such as porters, workers are able to work overtime on 1.5 pay rate, whereas in other departments workers are only given the option to work bank shifts on significantly lower rates. This is not an open dispute, it is still negotiated behind closed doors.
A second wage division opened up between regular workers and those who are on training and apprentice contracts. The Trust decided to exclude them from the 3% pay increase and back dated payments, as the apprentices ‘already receive the statutory minimum wages’, which was increased last year. Apprentices and ‘trainees’, who largely do the same job as everyone else, apart from very occasional training sessions, are not too happy about this. Even Sodexo agreed to pay the 3% increase to outsourced workers in South Yorkshire!!
Thoughts of a midwife…
The gap between those that rejected the 3% pay offer and those that voted in favour of industrial action was the widest amongst Royal College of Midwives (RCM) members (95% compared to 54%). Why is this? Discontent seems to be at the highest recorded rate amongst all groups of NHS workers, at the same time that willingness to strike to enforce a higher wage does not. While any kind of patient care makes it difficult to contemplate strike action, the nature of midwifery means that timely responses are totally inflexible. If a woman is giving birth, not attending to her and risking the death of mother and baby is something no midwife wants to have on their conscience. What can be done instead? This is an open question that would need midwives to collectively discuss where and how they can wield some power – with no impact on mother and baby. Here is a report about how conditions have deteriorated for midwives over the last few years:
Berlin healthcare workers take back some control…
We translated this interview with a striking hospital worker in Berlin. This struggle has been rumbling for some years, with little to show for it as unions kept capitulating to re-start negotiations, even when they were in a position of strength. Then, the unions decided to get serious: they paid 40 organisers to mobilise for this strike. Thousands of supporters were on the picket line – which was a great feeling after lockdown – and there were coordinated actions across different groups of workers and hospitals. The delegate system the interviewee talks about is interesting and might give us some food for thought over here:
Interview with friend in the US
Here is an interesting interview with a nurse in California where they talk about the impacts of violence, capitalism, covid and conspiracies on their work:
This article was published in the Czech medical journal ‘Tempus Medicorum’ in June 2018
The Nurses’ Initiative has been operating in the Karlovy Vary Regional Hospital (KKN) for a year and a half. That is why we want to recapitulate what it has managed to do, what it has not had the strength to do, what methods it has adopted and what obstacles it has had to overcome. We appreciate the opportunity to summarize our balance sheet in a medical magazine, we want to share our experience with the medical ones.
The nurses’ initiative grew out of KKN workers’ realization in January 2017 that no one would stand up for us. So far we have won for a triple pay rise in KKN from the regional operator. In addition, last summer, the hospital paid a “shift bonus” to all nurses and assistants (and to a lesser extent, to carers and paramedics). Without having to negotiate for it. We all received a ten percent increase, automatically, starting in January 2018. There was no negotiation required. We got better off, noticeably.
We gained more in one year than we had in many years before. It wasn’t free on our part. We had to take a step into the unknown and rely on a long-run self-organisation and pressure from below, from the ground terrain, on the regional politicians, but most importantly on the management directly in the hospital. First of all, however, it was necessary to understand that even in the hospital, in the workplace, where we cannot strike effectively, it is possible to fight, not just negotiate. The road to that understanding was not and is not easy. It is necessary to deal with the dictates of long-established stereotypes.
To sacrifice ourselve means to deepen the crisis
There are many of these stereotypes, and they are ingrained in the operation of hospitals and in the health workers’ mentality. We began to untangle them when we asked the question: Why do nurses, etc. endure the devastation to their work and personal lives and to the quality of care so submissively and for so long? The answer offered itself: First and foremost, because our profession is a caring profession and we have, unfortunately, been indoctrinated that it must entail a willingness to sacrifice ourselves. But that is only the beginning of the answer.
In fact, we were sometimes even proud of ourselves for managing the work for absent colleagues and other professions. Sometimes we hoped that the more we did so, the more “someone would notice” and take pity on us and compensate us. We believed that it was enough if our testimonies reached the media, the public. But the list of obstacles that stand in the way of the self-confidence of nurses and the lower healthcare staff is much longer.
However, a following trap stands in the way not just to the nurses’ self-confidence for the struggle: there is a belief that those in charge, the politicians, the management, are just uninformed and therefore have no idea. However, that’s wrong, they have had their plan, their “solution” how to get through the hospital crisis, for a long time: it consists precisely in sacrificing staff, nurses and doctors, and making us endure it. This was and is their “crisis management”. Very cynical because it exploits the fact that politicians and management are not in touch with patients, their loved ones and the crisis of care on a daily basis. We are. We don’t hide in our offices.
But even that’s not all, there’s still the “Become the unpaid Minister of Health” trap: when health care workers speak up, they are being asked to sort out the entire health care system. “Are you complaining that this is unbearable? Ok, so propose a different plan, preferably for the whole country,” we hear… Yes, after the n-th night shift in a row, the hospital staff should probably do the work of ministers, governors, hospital directors for free!?
“My job is to put patients to sleep and wake them up, yours is to provide the money to keep the hospital running,” one of us, an anaesthesiology nurse, replied to the appeal of a regional councillor to join just another, a millionth committee. Her answer was right! It’s time to finally start from the needs of hospital staff and their patients. To put the system on its feet.
But how? How to make our voices heard so that those in charge feel it, concretely, practically, in a service where we are not allowed to strike?
To say “no” to the patching up of the service
Last spring, KKN’s infectious disease ward was threatened with closure due to the staff shortages, and the county politicians toured the facilities in the region to lure the nurses to get a side-job by offering better rates. At the time, we urged our colleagues not to come to our infectious diseases wards to help out. It caused an uproar in the county. It was reported that “the Initiative was threatening colleagues”. However, the external nurses understood why we did not want such “help”.
When KKN’s internal medicine unit was threatened with closure this January, the surgical department refused to join. Out of consideration for the internal and surgical staff and patients. And subsequently, some nurses from eleven KKN wards wrote declarations refusing to help out in the internal medicine ward. For the “privilege” of the double pay for helping out in the internal medicine, management finally managed to find two nurses from the entire hospital!
To say “no” to such patching up, to refuse to participate in such faking of the service, required courage, planning, organization and great responsibility. However, it was the understanding that it was such patching up and fiddling that brought the hospital, and not only ours, to its present state. Overpaying nurses from other departments and from outside the hospital, not following adaptation processes, forcing staff to go beyond their competencies and job descriptions… These are the ways of not solving the crisis, but prolonging it. If the managers and politicians refuse to take responsibility, the workers have to.
It’s about working conditions, not just the money
We have not opened the balance sheet by listing what we have achieved in terms of wages for the sake of boasting. After all, we did not achieve our demand for the introduction of national pay grades in the KKN. Regarding the pay grades, politicians, led by the regional governor Jana Vildumetzová and the councillor Jan Bures, as well as the management of the hospital director Jitka Samáková, deceived us for many months with promises that were only meant to calm down the KKN staff. When the time came to meet the promises, they ran away from them. We do not forget this. Nor do we forget that the state is increasing wages by 10 per cent in our sector, which has long been underfunded, in a situation where wages, and therefore competition, are rising throughout the labour market.
In taking stock of our experience, we wanted to move from the obvious to the harder but more important issues. We started with money to emphasise that it is not just about money. It is not a sensible choice to accept the devastation of one’s own profession and life, the decline of patient care, the deterioration of working conditions in exchange for more money.
It is all about refusing to cooperate with management and politicians in their gambling with care, in their trampling on the profession, in devastating the working and living conditions of the staff, nurses and doctors. The big “no’s”, of which we at KKN have only been able to say “a few” through much of the hospital, are obvious. But it is the small “no’s” on the ground in the workplaces which really matter: to refuse to do the work instead of another profession (important, but not my job!), to insist on having a break or its reimbursement, to refuse to exceed the workload, that my superiors force me to do because of the staffing crisis and thus risk legal action against me, to refuse to have a staff “reinforcement” assigned to the ward, who as a non-nurse is supposed to do the nurse’s work and for whose misconduct I will then be responsible…
Such “small” but immediate “no’s” will get inscribed into the self-esteem of the staff. They have the power to change the practices of the service. They require individual courage, collective intelligence and co-operation. They are the “no’s” of breaking the rules. It is a method of struggle how to push, step by step, from below, from the practice, for a solution. How to create, through our own responsibility (for our own health and our lives, and for the health and lives of the patients), a situation in which politicians and managers can no longer run away from their responsibilities. To ensure that the impact of us sticking to the rulebook will reach from the bottom of the hospital, through the middle ranks, up to the top levels and above the hospital, to the national level.
We are very grateful for the opportunity to look back on our year and a half in this medical journal. For many reasons. Because we share a workplace with the doctors. Because it is good to exchange experiences of fighting for better money, conditions and greater professional pride, which the crisis in hospitals is taking away from us (after all, it was from the experience of the doctors’ movement “Thank you, we are leaving” that we started to organize). Because the better working conditions the doctors and nurses have, the easier it will be to work together.
The nurses’ initiative
Two leaflets from the Initiative:
Experience from practice: how we fight in our department
Even a “small” rebellion on the ward is the beginning of a journey towards self-confidence. The following “NO” (“NO” to regulations’ violations) experiences are proof of this. They may seem “trivial”, but at KKN they have actually opened the way for other “NOs”, they inspired and gave courage. They set an example. And in the end, with other “NOs” from other departments, they created a collective force and generated pressure. And from the other side – they required courage to start, to hold the line and act as an organized collective.
Our experience is from the central operating theatres: we agreed collectively that we did not want to refuse overtime work (each of us had her own reasons). Therefore, we were looking for another way how to put the management under pressure.
The very first thing was the observance of lunch breaks. As simple as it sounds, even that was a fight. Following the Labour Code, we began to take our lunch break at peace, no later than 1pm. We had to break their resistance to get that.
The next step was to comply with the standards when admitting and handing over the patients: from now on, nice and easy, with regard for the patient, not at mad speed. Not as before in a rush and with an often stressed out patient on the operating table.
Then we looked around for what other regulations say. Hygiene, for example. These, for example, impose an exposure time for each disinfection (but we can call it a “mopping break” because that’s what the term means :)). So? So, after wiping, we began to wait for 15 minutes, as our disinfection rules require. Only then we moved on to the next patient. Sure, it may sound boring, too basic, but what a fight was it! “Who do you think you are?” “How dare you to slow down the procedural order?”
All these little steps, one after another, led to a general outrage. It took a long time to get them accepted even by those who should have followed them in the first place.
And what has it given to us? Many gains, in every respect. For example, we don’t slip on wet floors anymore, we don’t breathe in the fumes of disinfectant solutions (there are studies on the harm of inhaling these fumes over a long period of time), operating rooms are disinfected as they should be. We eat lunch around noon like humans. We don’t rush around as we used to. Patients benefit from our approach.
But it has brought out something extra, something that actually reaches beyond our department. Someone may believe that these are just some small things (but those who deal with such things know that changing them is not an easy ride). But when more and more departments start to change the existing, established way of working on similar “little things”, when the amount of those little things grows and grows, many little flames will turn into fires. And gradually they will burn their way up to management. And yes, eventually management will realize that the old ways just don’t cut it. That we need to bring in new nurses. That there is no other option – that it just can’t and never will be done without nurses.
Each department has its own specifics, its own procedures. But working conditions can be improved everywhere. This is for a longer conversation. Everywhere you can “use a lever” to change the stereotypes (and the given awareness of nurses). It just needs taking a distance from the learned, from the automated. These are all steps that are consistent with the standards, regulations, the Labour code. They are all by the book. No one can accuse us of doing something wrong, let alone punish us for it.
Of course, many of us have been targeted by colleagues who, from a position of power, thought they could bring us back to the “obedience”. We stood our ground. And we will continue to fight in this way. Firstly, because although the leadership in KKN promised us the national pay grades, they have not kept their promise – and we do not want to work with someone who does not keep their promises. And secondly, because we aim to straighten our professional pride and working conditions for good.
Finally, I would like to say that it is sad that we as health professionals have to use sticking to the Labour code as a threat. After all, it should be the alpha and omega. That is why it must be emphasised: the entire health sector today is based on non-compliance with the Labour Code, and those responsible are ignoring this dangerous fact.
It is up to us to change this.
How to seek a pay rise in your hospital
Union negotiations with the government are unlikely to yield even 10% pay rise. In any case, they will guarantee less than a quarter of a percent pay rise to the staff in private health care. They have been thrown over the board. However, they (but not only them) have a chance to gain more. Hospitals will get a record amount of money from the government through the compensation scheme. Now the point is to force our managements to spend these money on wages. To give it to the people who keep the health care afloat. To those to who the management owes a lot. To those who are paying for the staffing crisis without having had caused it. To give it to the staff – nurses, assistants, carers, paramedics, doctors, cleaners.
To force the management… Does it seem mission impossible? It’s not impossible. We have a proof, an example, that it can be done. The first issue of our paper will be about how to do just that.
Yes, we can! An example from the Karlovy Vary Regional Hospital (KKN)
Three pay rises in one year, which also meant that some of the nursing categories in the joint-stock company get better basic pay than according to the national state pay grades. Shift allowance from summer 2017 for all nurses, not just those on shifts, and to a lesser extent for others, nursing assistants and paramedics. As of January 2018, the national 10 percent rise. Better working conditions on the militant wards. And above all: more self-confidence in relation to the management.
This is the result of the struggle that began in February 2017 at KKN. Yet, as recently as December 2016, no one there could have imagined that such a thing was possible. At the beginning, there were several female colleagues. Gradually, the initiative grew into a self-organisation, a force that was able to put a lot of pressure on the regional government and on the leadership.
The Initiative made it in KKN also because it understood the following:
Staff must stand up for themselves. Poor pay and conditions are also the result of relying on “someone to sort it out for us” (unions, media, politicians, labour inspections…).
The strength is in the departments uniting from below. In practice, this meant mapping and comparing workplace conditions, our own meetings (outside working time), producing a newspaper, setting up different whatsapp and email groups…
→ We need to have the basics of self-organisation before we start talking to management. Not the other way around.
The strength is in the struggle, not in negotiations! Our potential strength (read on to see what it may look like) is in the hospital, in the terrain, in the wards, on the job, not in the office at a negotiating table.
→ The principle is: as much direct pressure as possible from the bottom of the ward first, negotiation afterwards and as little as possible.
We don’t care where the employer will find the money for higher wages. “We don’t have the money for wages”, “we are in debt” are the first answers we hear. In KKN, the nurses said, “You – the politicians and management – don’t care where we find the money to pay our bills from our miserable wages, or who is looking after our kids when we are doing the n-th shift in a row… We, in turn, don’t care where you get the money for higher wages.”
→ Let’s not get sucked into the responsibility of “finding resources”. We’re nurses, assistants, carers, paramedics, we’re not managers – that’s their job. Let’s not get sucked into the task forces and endless meetings.
The struggle, the pressure, must be based on the conditions in specific wards. Perhaps in every hospital, in every ward, operations are “patched up” with overtime beyond the legal mandatory limit, with violations of regulations, job descriptions, standards… If we say “NO” to this, management will have to back down.
→ There is no single method of fighting. It has to fit the workplace. But the fight must be coordinated.
We need to be radical and patient. It’s not just a fight with management. It’s also a fight with passivity, obedience, the mentality of “don’t get yourself into a trouble…” and “the negotiation is still on, just be patient and see how it turns out, the fight is not appropriate at the moment…”. All of this has intoxicated our departments for years. It’s taken its toll on us. It’s a long haul to change that.
There are many more lessons to be learned. These are the most basic. Others will be spelled out in the future issues of the paper. And you yourselves will discover yet other lessons as soon as you will you launch yourselves into building self-organization and struggle (with us). Contact us!
Let’s be strong and smart = let’s organize, independently, from below.
I am a part time community midwife in a small town in west England, employed by the NHS trust based in the nearby city. We are a small team doing the antenatal, postnatal and home births for the area, much of which is rural.
The past year and a half, since covid started, the workload has definitely increased and intensified. Mostly due to staff sickness, and staff leaving. Most face-to-face workers I know have some kind of exit strategy, or would like one. Either trying to get a specialist role that is less about constantly working at the ‘coal face’ or leaving to do something else all together, or early retirement. These are midwives with years of experience and knowledge. Although apparently something close to 30% of newly qualified midwives leave the profession within a few years.
We work to strict and fairly inflexible work guidelines in terms of procedure, paperwork and admin, all the things that need to be double-signed, checked, followed up. And of course the care that needs to be given can’t be put off for another day. If a newborn baby and mum need a home visit the first day back from hospital, it does have to be done that day. I am supposed to work an 8 hour day, but if I am the only one from my team in, and I have to get through the work of the day in terms of the women and babies who need to be seen, plus all the various procedures, it does not fit into 8 hours. So I often leave work an hour or even two hours late. I can put this on my time sheet as extra hours, but still. I am a single mum and my childcare arrangements often have to be stretched and bent and I ask people for favours all the time due to being late home. You can’t really run the service we are expected to run, and keep to all the guidelines, and have the number of staff we do. It just doesn’t fit. There is a constant looming fear that you will miss something and it will be your fault. That you will either get in trouble with management, or of course worst of all, a baby or mother will get sick because you missed something. They try to keep the quality of work up by threats of ‘loosing your PIN’, but its not a great motivation to be honest. When I worked on postnatal ward and we were so busy that you sometimes didn’t see women for hours I had a dread of someone dying or getting seriously ill on my shift and it would be my fault. In another trust I worked in we used to put in ‘datex’ for low staffing so that if something happened it would be clear that we had seen it was an unsafe situation and had tried to escalate it. But management told us not to do that. We were trying to legally cover our backs, and raise the issue as a problem.
There has been a big national re-organisation of midwifery in the past year. Yes, in the middle of a pandemic they have totally restructured the work organisation. It is called Continuity teams and comes from a report called Better Births. The aims are laudable and were intended to be more woman centred, but does not really work in a regimented hierarchical NHS system based on shift work and structured work hours. In practice it means most midwives doing some community work, and then either some 12 hour hospital shifts or 12 hour on-calls. This is leading to exhaustion and burn out. The idea is that the birthing woman knows her midwife, but it is organised in teams of 8, so it can feel a bit like a tick box exercise. Independent (non NHS) midwife teams worked with continuity, i.e. the midwife you see in the pregnancy also attends the delivery, but they had a much greater level of trust and autonomy for the midwives. The midwives could organise their own timetables to ensure the work got done. Expecting the level of continuity and night and weekend work, without the respect of being able to organise your own workload feels like a strain that might not pay off in the long run. As it is a government led initiative, all trusts have to implement it.
At work we don’t really talk about the pay issue so much in specifics. Of course we moan about the pay. The band 3 maternity care assistant work as hard as the midwives, doing many of the same duties, but get much less. Mostly it is seen as a given that it is relatively low paid work and people try to manage by doing weekends and nights, or thinking of a way to leave midwifery. The ‘heroes and angels’ narrative was really annoying on this level. The idea that we are selfless workhorses who do it because it is a calling is irritating when you are late home from work, hungry, the kids haven’t had dinner and the pay is low.
– Interview with a nurse and trade union representative on strike in Berlin
We translated this report because it goes beyond the usual ‘mobilising’ strike announcements, but instead provides a little more background. In the near future we will try to write up further thoughts on the Berlin hospital strike, including a critical reflection on the trade union strategy, based on conversations with local health workers. You can read this article to understand the wider context. Despite various limitations, e.g. a strike participation of only around 20% (also due to legal emergency cover), we can still learn a lot from our fellow workers in Berlin – in preparation for future disputes here in the health sector in the UK.
On the 23rd of August 2021, workers of the Berlin hospitals Charité and Vivantes went on a three-day warning strike. The strike included the outsourced service workers at Vivantes. This was preceded by an ultimatum of 100 days, which the Berlin Hospital Movement (an alliance of initiatives and unions) had issued to the Senate (local government) and the employers of the state-owned hospitals on the 12th of May. The trade union demanded a serious offer concerning staffing levels, so-called ‘relief’, and pay and conditions according to the collective agreement for the public sector (TVöD) for all employees of the outsourced subsidiaries. The Senate and employers let the time pass unused – the health workers made good on their announcement and went on strike. Vivantes initially had the walkout banned by a temporary injunction from the labour court. The reason given: The medical care of patients was not secured because no emergency service agreement had been settled between Vivantes and Ver.di (the responsible trade union) in the run-up to the strike. However, the injunction was overturned a short time later at the labour court, and the walkout at Vivantes could begin.
In the meantime, it is clear that the strikes will continue. Today (6th of September 2021) Ver.di published the results of a strike ballot: about 98% of the union members at Charité and Vivantes voted for further work stoppages.
These latest disputes continue a long-standing movement for more staff and relief at the hospitals. The struggles at Charité played a pioneering role in this (for the history, see the Ver.di brochure “If there are more of us it is better for all”). Following on from the Berlin experience, a movement for a collective ‘relief’ contract, which would allow for better staffing ratios, also formed in the region of Saarland from 2017 onwards. In these movements, strikes were held on the basis of emergency service agreements in which the employer was given responsibility for patient safety. Another novelty was the model of ‘collective bargaining advisors’ or team delegates. These delegates, which are supposed to be in close contact with the team nature of day-to-day work, should create a strong feedback loop between the collective bargaining process and the ran-and-file on the shop-floor.
We talked with Anja Voigt about the latest struggles. Anja is an intensive care nurse at Vivantes, involved in the Berlin alliance “Health not Profits”, Ver.di member and part of the collective bargaining commission.
Communaut: Before you went on strike, you gave the senate and the employers a hundred-day ultimatum so that they would make you an offer for a collective agreements. Since there was no movement at all on their part, you now went on a three-day warning strike. How did you decide to use the ultimatum as a means of struggle?
Our thought behind it was that the time was ripe for a renewed fight, since nursing and the hospital have received a certain amount of public attention through Corona. In addition, in September there is the election for the House of Representatives in Berlin. So the months from May to September were a good timeline to put pressure on politicians. If we simply stood up and demanded a collective agreement on relief, probably no one would have noticed. That’s why we tied the demand for a new collective agreement to an ultimatum, saying, “If serious negotiations don’t start by the end of the ultimatum, we’re going on strike.”
Did the idea of the ultimatum come more from the union side or from the workers?
The idea came more from the union, but really only the idea. A lot of colleagues were involved in the whole implementation, who in turn asked their colleagues: “Do we want to do this? Is this something that can bring us success?” The idea alone would not have been enough. When we asked our colleagues if they would take part in industrial action, they were beating down our doors. They were really up for it. The pressure on health workers is now so great and it’s clear to everyone that things can’t go on like this in Berlin’s hospitals.
Does that mean that there is currently a high level of support for the demands and a high level of participation in the strike?
Yes, there is a very high level of support. We started with a petition to find out whether our colleagues wanted to take part and whether the demands were important to them. More than 8,500 colleagues signed the petition. The approval of the demands for relief (better staffing levels) was also clear in the last TvöD (collective contract for the public sector) negotiations in October, when Ver.di asked what we would like to see negotiated. It emerged that many colleagues are no longer interested in a pay increase, but in more staff. More money is nice, of course, but it doesn’t solve the current problems. On the contrary, the current workload is causing more and more people to leave the nursing profession. In order to stop this, fundamental changes must finally be made.
How do you organise yourselves on the hospital level and, above all, between the various hospitals?
Initially I was unsure if a simultaneous struggle in two hospitals would work. I had doubts about whether it could work. Vivantes alone has nine different locations, the hospital campus is vast, while Charité has three large complexes. Nevertheless, we wanted to bundle our demands and develop a joint movement. I have to say, it’s working brilliantly. Social media are wonderful for such purposes, especially telegram channels, etc. We are much better networked today than we were during the collective bargaining disputes two years ago, which is really impressive. I suddenly know colleagues from the Benjamin Franklin Hospital or from Spandau with whom I had never been in contact before. Now we know each other and are aware of each other’s problems. The greater networking also leads to enormous cohesion between the colleagues, which of course also makes us stronger. I haven’t experienced that in recent years – and I’ve really been active in the union for a long time. A really strong movement has emerged. You can also see this in the fact that – albeit slowly – small success are becoming visible. We can move a lot due to the size that we have now.
Is your networking ‘only’ digital or do you also meet in person?
Of course we also meet in person. That’s very important for the exchange of ideas. But it’s striking how much easier communication has become thanks to social media: In the past, if there was something important to communicate that affected everyone, in the worst case we would write a newsletter. It would then be on the road for half a week until it reached the last area. Some people didn’t receive the information until 14 days later. Today, you send something to the telegram group and 5,000 people know about it immediately, which is a great relief and makes union work much more interesting for me, because you can reach so many people so quickly. That’s really fun.
How did you come up with your demands, is it more top-down? Are they Ver.di demands or do they come from below through your networking?
No, it’s not top-down at all, quite the opposite, it starts at the bottom. We have started – very laboriously – to talk to every single colleague. In their teams and on their wards, colleagues asked other colleagues. In this way, each colleague conducted a so-called demand interview, in which they were asked what their work situation was like, what was stressing them, what was needed to improve the situation, what was needed to reduce the workload, and how many staff would be needed to do a good job and to be able to care for patients well. We then gradually bundled the demands that were mentioned in the hundreds of interviews and used them to draw up systematic demands. Nothing was dictated from above.
For some years now, Ver.di has had a system of team delegates for labour disputes, here in Berlin and beyond. Can you describe how this works? Do workers have more of a say vis-à-vis the union leadership than before? How do you see the relationship between union activists and Ver.di in general? Ver.di has not always covered itself with glory in the past – for example, during the Charité strike.
This is now a very broad and democratic process. What I have just described with regard to the demands also applies to the feedback from the other side. You can think of it roughly like this: A ward has about one to three team delegates, depending on its size. On the one hand, these team delegates maintain the connection to the collective bargaining commission, i.e. directly to the main Ver.di office, and on the other hand they feed all the information back to their team. It is no longer just one person from each hospital building who sits on the collective bargaining committee and has to establish a flow of information to the entire workforce, but there is now a direct link between ward teams and the main office. For example, we have a meeting of the collective bargaining committee today and afterwards, at 5 p.m., there is a Zoom meeting with all team delegates from Vivantes and Charité. We then report to everyone what happened today and what we have planned. The team delegates then have the opportunity to give us feedback. So it’s not just a one-sided address from us and then the meeting is over. If the team delegates say they don’t agree with what we agreed to in the bargaining committee, then we don’t do that either. We don’t even make important decisions without this feedback.
This system of team delegates makes a lot of the female colleagues feel more involved. They no longer have the feeling: “Now we’re back to collective bargaining and Ver.di will say what’s going to happen, and then we’ll stand there with a flag and go on a warning strike and it’ll be fine.” Instead, they have the feeling that what is important to them also reaches the union and is negotiated directly. It’s about their needs and the needs of their patients on the ward. That’s what makes this movement so special.
You are currently fighting two battles at Vivantes at the same time: On the one hand, the nursing staff fights for the collective ‘relief’ agreement. On the otherhand, the outsourced workers of the Vivantes subsidiaries fight for the integration into the collective agreement for the public sector (TVöD). How did you manage to combine the two struggles? That’s sometimes a difficult thing to do.
Yes, that’s incredibly difficult, especially to make sure that the struggle remains simultaneous. But it was important to us from the very beginning to make clear that we are one hospital and that everyone in this hospital works together. That’s teamwork. The nurse is no better than the cleaner, the handyman or maintenance person no less important than the radiographer. Only together can we provide good patient care. It’s really special that we’ve managed to bring so many people with different demands along with us. At the moment, the nursing staff is fighting for a collective agreement to reduce the workload, the subsidiary workers would finally like to be paid fairly, and yet we are fighting together. We also hold joint collective bargaining committee meetings and exchange information together digitally. When the management of the subsidiary company comes up with a new offer to negotiate, we are invited to join in and discuss it: “You want to go on strike now, it doesn’t really suit us right now, but we can support you.” That’s always a very productive exchange. I find it very inspiring. It creates a close cohesion within the hospital. Suddenly you say hello to the cleaning staff early in the morning, who you didn’t even notice before. I also find it impressive that at the strike demonstration last week, colleagues spontaneously took to the stage and spoke in front of 1,000 people who no one else would have noticed. All of a sudden they are visible in their function and position.
Can you assess how the willingness to fight has changed as a result of Corona? Have you noticed any changes compared to before?
This bad situation in the hospitals existed before Corona, of course, but it has become even worse, the workload has increased further. In addition, there is the factor that I mentioned earlier: We got more attention and publicity because of Corona. It makes the fight easier when you know that many people and the general public are behind us. I also believe that the willingness to fight has increased again as a result of the stupid applause. Many of us felt fooled by it and now say, “You can stop the nonsense, we really want a change now and now we’re going to do something.”
At the Charité, and also at other public hospitals, the strikes of the past years were based on the regulation of a so-called emergency service agreement. This plays a relatively important role in the enforcement and organisation of strikes in hospitals, and in your case there has even been a court case. Can you explain what exactly an emergency service agreement is and how it comes about?
The concept of the emergency service agreement was first developed during the big Charité strike in 2015. Until then, there were virtually no strikes in hospitals. Maybe people from reception occasionally engaged in symbolic pickets but otherwise it was always said: “We can’t go on strike because our patients won’t be cared for.” This led to great frustration among hospital workers. As a result, the union at the Charité came up with the emergency service agreement system. With this agreement, the union gives the employer sufficient notice that they want to strike. The employer is then responsible for ensuring patient care. To put it bluntly, the emergency service agreement says to the employer: “We won’t be on the ward tomorrow morning, so make sure that there are fewer patients.” This makes it possible to delegate responsibility to the employer, which is why this emergency service agreement is so important. In the meantime, hundreds of such agreements have been concluded in many hospitals in Germany. In the meantime, however, it is no longer quite so easy to enforce. In the past, it was a matter of settling an emergency service agreement for three warning strike days. Today, and especially in Berlin, we are no longer talking about just three days. The employer also knows that and naturally says, “No, not with us.” It is no longer enough to simply indicate that we will walk out. There are now negotiations back and forth and in the end the employers don’t want to settle for an emergency service agreement. But then we go on strike anyway because it’s our right and we have an emergency service agreement in place that we abide by. This means that our patients are not at risk. This has now also been confirmed to us in court in the current dispute.
At the beginning of this warning strike, Vivantes first managed to enforce a banon strikes by means of a temporary injunction. What would you say was the strategy behind that?
The employer’s strategy was quite simply to prevent the strike. But it didn’t work; on the contrary, it backfired for Vivantes. During those three days, the willingness to fight grew even more because people were angry. The employer shot themselves in the foot, and I don’t think they expected this. We were proven right. It was also very important to many colleagues that we were not deprived of our basic rights just because we work in a hospital, but that it is clear that you can also strike responsibly in a hospital. It also annoys me in the public debate when people act as if we were irresponsible. None of my colleagues walks out, drops everything and we’re gone. We always check to see if someone else is there to do the necessary work. And we agree: “If you stay, I’ll go out, tomorrow we’ll do it the other way around.” That goes without saying. We took on so much responsibility in the Corona crisis, we didn’t run away. Of course, we won’t do the same in the event of a strike.
When the strike at Vivantes was hanging in the balance, did you discuss among yourselves what you would do to get around it if the strike ban remained in place?
The first moment the order was announced, we were all shocked. Then we quickly regrouped and thought about what we would do now. It was clear to us very quickly that Vivantes would not be able to get this emergency injunction through. A judge had decided that in a rush, but we knew that we had a good emergency service agreement and that we would get justice in court. And with this conviction that we would win, we went to court and won.
The managing director of Vivantes, Johannes Danckert, likes to emphasise that he is also in favour of relief agreements, but that one hospital alone can’t do anything and that more money and, above all, political solutions are needed at the state or federal level. How would you answer him?
I would tell him that he is absolutely right. The hospital financing system urgently needs to be reformed. Political solutions are needed, no question about it. We’re all with him on that, and we’ll also join him in the streets to demonstrate for that. But in the current situation, it’s up to Berlin’s state politicians, and we’re putting just as much pressure on them as we are on the management. We are always told by the management that they can’t decide anything and that the money has to come from politics. But we talk to them just as we talk to our management. As a city, as the capital of the Federal Republic of Germany, we have to think about whether we want to provide good services of general interest, healthcare that is fair to everyone, patients and employees alike. If you want that, then you have to spend money on it.
Now there is an emergency service agreement. How many employees were ultimately able to take part in the warning strikes and demonstrations?
There were 2,000 people at the strike demonstration on Wednesday. That was very impressive. There is still no emergency service agreement that Vivantes would have accepted. There is one that we say is good, that the employer could sign at any time – but they don’t, although it has also been confirmed in court. Nevertheless, many colleagues can go on strike with this emergency service agreement. I can’t give exact figures now, but certainly half of the colleagues were able to take part in the strike.
Only nurses and other staff went on strike: what is your impression of the doctors? Do they support your demands and the strike?
It always depends on the level of the hierarchy. The assistant doctors, i.e. the medical colleagues who work directly with us, see our daily misery and therefore support the strike. There is even a medical petition that many doctors have signed – including chief physicians or senior physicians, i.e. people in management. They also know that they cannot fully occupy their beds because there are not enough nursing staff. They don’t often say this so openly because they are also under financial pressure and sit in management positions. One question that always gets me is why we don’t all get together, from the nurses to the head physician – or even the management – and put our foot down and say: “This simply can’t go on any longer. Something is financially sick in Germany’s hospitals.” We still have to get that together.
In Berlin, there is also a lot going on, also outside of the hospitals. The railway workers, who also work in the public sector, have gone on strike; at the delivery service Gorillas, there were so-called wildcat strikes recently; there are protests against the expansion of the autobahn – are there mutual references and solidarity between these struggles?
Yes, there are solidarities. Just a short while ago, we were at the AWO (charity and big care employer) workers’ strike with our collective bargaining committee. Colleagues from the GDL (train drivers union) visited our strike. We are networked among ourselves and there is support everywhere. Sometimes it seems to me that a lot is happening here this summer. In Berlin, people are setting out to fight for a better city.
During the first Corona wave, there was a lot of talk about care work and the poor working conditions. Do you feel that there is more solidarity and understanding for your demands from society than during labour struggles before the pandemic?
In my perception, people have always had understanding. They just could never understand how you can go on strike in a hospital. Many were afraid that we would simply leave the patients behind. I think something has actually changed. For example, when I was standing in front of the hospital’s strike picket during the warning strike, an elderly couple came up to me and said, “It’s right that you’re on strike, that’s a good thing. They canceled my X-ray appointment, but that’s just the way it is.” I have the impression that the population knows that something has to change. People also understand that they have to actively fight for change and can’t always just start a petition. They understand that sometimes you might have to confront people head on in order to change something. Then a medical appointment might have to be postponed sometimes.
Now you have carried out the warning strike. What do you think, will the hospital management come to the negotiating table? And will the workers vote for an indefinite strike in the ballot on Monday?
In any case, you can see that our pressure has been successful and that something is moving. In a meeting with Vivantes management today, they used the word “negotiation” for the first time. That’s more than they did three weeks ago. It’s still not concrete, because the management hasn’t made any proposals yet, but at least they are now signalling their willingness to sit down at the table with us. But we need to keep up the pressure. We can’t let up now, we have to step it up a notch if we really want to achieve a positive result. I am very sure that the ballot will be positive and I assume that around 90 percent will vote in favour of a strike.
The demands that were at stake during the ultimatum and the strike concern collective bargaining issues. However, there are a number of demands that go beyond this, for example in the ‘Health not Profits’ alliance, in which you are also involved – such as the abolition of the fee-per-case system and your demand for a solidarity-based healthcare system without profit logic. What could such a healthcare system look like and what would have to happen for it to actually be implemented in practice?
There would have to be a different financing system. In the entire health sector, both in hospitals and in outpatient services, rehabilitation facilities, nursing homes, etc., the focus should not be on competition and profits, as is currently the case. No fire department, no school, no library has to make a profit, why then in the care of the sick? Something is ethically wrong. What is needed should be financed. If I’m sick, I need treatment, and that needs to be fully financed. The state must pay for this financing. We would not deny that it is also possible to work economically. But care must not be linked to whether an operation is particularly lucrative, and it should therefore not be prioritised over other cases. It cannot be the case that financial considerations determine how one is treated. We still have good medical care in Germany, but profit orientation absolutely must be abolished. Nor can taxpayers’ money and health insurance contributions be used to finance a system in which, in the end, some shareholders can pocket profits. That is crazy.
Do you think that such a health care system is possible within a capitalist society? Many people say that housing should not be a commodity – and why should food be a commodity? But in fact, almost everything around us is a commodity. Do you think that a needs-based supply is possible within this logic and that the state will simply step into the breach?
I’m quite sure of that, because that’s how it was in Germany until 2003. Until then, at least, the hospital financing system was not based on competition, but on need. Of course, there was a lot of corruption and abuse of power. But at least no hospital had to make a profit and be in the black. If the will is there, it is possible to turn this around again, perhaps not overnight, but as a trend. Even within the German Hospital Association (DKG), there are already such efforts. It is also clear to them that things can no longer go on as they are now.
Another of the alliance’s demands is an equal distribution of care work between the sexes, whether private or professional, instead of cementing it as a task for women and families. Could you elaborate on what you mean by that exactly?
In our society, it’s clear who provides care: 70 percent of the people who work in hospitals are women. In the private sector, in the domestic care sector, their share is even higher. It is a task for society as a whole to rethink this. This starts on a small scale, for example with parental leave. How many men take parental leave these days? There are still very few, even though more and more are doing so. There needs to be a change in thinking, and society needs to promote the idea that caregiving tasks are shared equally and that it is not the sole task of women to provide care. Men can do that just as well. If care work is always shifted onto women, this leads to women working part-time because they are still caring for relatives, for example. Then they automatically earn less than men – an endless spiral that we have to get out of.
You are also fighting against the lack of autonomy at work and the hierarchical division of labor. What exactly does that mean and how would you like to organise work in care differently?
I can report from my own experience at work. It’s often the case that it’s not us, but the doctors who decide what needs to be done. It often happens that the doctor intervenes in my profession more than is reasonable. That is a problem, because I have learned the nursing profession and I can and want to determine independently what is good for the patient from a nursing point of view. In German hospitals, however, it is not at all common, or only to a very limited extent, for nurses to have a say in treatments or in questions of care. Too often, the focus is primarily on medical issues that the doctor orders and the nurse is supposed to carry out. If we are to achieve a better appreciation of our profession, it must end with others telling me what to do. Of course we should work together with the doctors, and in many cases this works very well. But we don’t need these hierarchies.
In many hospitals, there is still only a medical director and an administrative director. Where are the nursing staff? We are the largest professional group in the hospital. Many hospitals now also have a nursing directorate with equal rights, but not everywhere yet. That urgently needs to change. To do that, we as nurses have to become even more self-confident. We really have to stand up and fight for this; we have let this happen to us for far too long.
Are such ‘marginal’ topics, which are very important for developing self-confidence in everyday life, topics that you also discuss in the current dispute?
Yes, they are topics. That’s why this alliance exists. We started with the demand for more staff in the hospital, but in the meantime we have gone much, much further. This feminist perspective has become much broader and bigger, but so have many other issues. They’re not always all equally present, but we’re always trying to focus on new issues as well. For example, we have also started to network more closely with the climate movement, because there are many points of contact there as well.
When you’re at a demonstration with 2,000 people, are there also sometimes nurses who carry a self-made sign that says, for example, “Abolition of the hierarchy” or something similar?
Yes, there are. This is becoming increasingly important, especially among younger colleagues. At the moment, the main topic is the need for more staff, but precisely because it’s about better working conditions, other issues always play a role as well. For many colleagues, it is an important question how self-confident and independent they can be in their profession. If I work in a profession where I’m always controlled by others, then at some point I get fed up.
From time to time, there are calls for hospitals to be taken back over by the local authorities, or the demand for ‘re-nationalisation’. Now we are dealing with public hospitals at Vivantes and Charité. Doesn’t the need to strike here, too, because working conditions are bad, make it clear that an even more radical change is needed – perhaps in the direction of a care revolution – in order to fight for a health care system based on solidarity?
In municipal – public hospitals, one already earns better – in Berlin, you are only paid according to the better standards of the TVöD if you work at Vivantes and Charité. So although our working conditions are poor, they are still better than those of our colleagues in other hospitals. I think that remunicipalisation is the right way to go. At the very least, all clinics should be run by non-profit organisations. Private clinics should be abolished, as they are only interested in making a profit – especially the large hospital operators such as Asklepios and Helios. Of course, we can think about a revolution and whether we need a market economy at all. But for now, I’ll start on a small scale, with our struggles.
Welcome to the third newsletter for a workers-led NHS pay dispute! The the internal consultations of the various unions about whether or not to engage in industrial dispute over the 3% pay decision by the government are drawing to a close. As health workers who take active part in the pay campaign we think that the most likely outcome is that the unions will announce that their members didn’t give them the mandate to mobilise for industrial action. This doesn’t mean that the dispute is over for us! The work-stress and low pay will continue and we will continue finding ways to confront this dismal situation.
* Both trust management and unions will say that they cannot do anything about pay and staffing levels, as these are allegedly ‘national issues’. This is not true. Trust management can find money to increase bank pay during certain periods, such as the summer holidays, or pay certain groups of workers more for ‘recruitment and retaining’ purposes. If your local union branch – or you as a collective of workers! – wanted you could engage in official industrial dispute over these pay issues on a trust level.
* There is a huge gulf between the low participation rate of workers in the union ballots and the mass of people who leave the job because they had enough! People are angry, but the unions are too far removed from the day-to-day on hospital wards and in the community health centres. As some of the reports in this newsletter show, the individual trade unions rather engage in pretty pathetic separate pay campaign activities, such as remote drop-ins, than visible joint rallies!
Let’s not give up hope in either way: there might still be enough people willing to vote for industrial action – and if not it just means that we have to find new forms to fight for better conditions for workers and patients!
For people who, like us, have difficulties to get their head around how the whole pay increase issue works we have summarised the basics below.
We need to share our experiences, please send us your ideas and observations: email@example.com
* Comments from Birmingham
When I discuss the pay campaign there is general agreement that yeah the “3%” is an insult and yeah you shouldn’t stand for it and yeah strike action seems pretty reasonable under the circumstances. Then comes what you have been expecting and dreading “Nurses can’t go on strike”. I ask why and get all the answers you’d expect:
“Nurses in the UK have never been on strike” – Not true. Nurses in Northern Ireland successfully went on strike in 2019/2020 over not getting a pay rise in line with the rest of the UK but they tells me they don’t count, it’s not really part of the UK. Well that might be true you think in an abstract sense but that’s another argument. However it does seem to reflect a way people feel, we can’t do it because we never have.
“What about patient safety, they’ll die if we do” – I point out that they’ll die if we don’t, more and more nurses will leave the profession and less new ones will join. We’ve already got a nursing crisis and this will only make it worse. Any way the Northern Irishes strike was able to be done safely and nurses around the world have managed many times.
“We’re the most trusted profession in the UK. We can’t ruin that.” – I ask what’s good trust if we’re not respected. They says we are. You say does 3% feel like respect?
This goes on for a while as they bring up stuff like the miners how they were crushed. In the end they agree 3% is not enough and something needs to be done, that they’ll be voting against accepting with the union but that to them strike action is just beyond the pale. I get the feeling that although it was the only one there making this case it is probably more representative of nurses in general.”
* Report from Bristol
I took part in a UNISON union drop-in for the pay campaign. The problem was that the union only emailed and texted individual members and that the drop-in took place in a pretty remote tent structure – many of the colleagues I asked didn’t know where it actually was. So it wasn’t really a surprise that only a dozen or so people turned up, out of 8,000 plus hospital workers.
I asked the branch secretary if the joint union committee, which comprises the half a dozen unions recognised on site, could have a joint rally, in order to attract more attention, also from workers who are not members of any union. He said that the unions decided to have separate actions, also because they have different pay demands. He added that the RCN action mobilised less than ten people. After the first two weeks of campaign only about 10 to 15% of UNISON members were said to have returned a vote, which is pretty bad.
In the meantime the trust management reacts to pressure from below and announced that they have over 30 new nurses starting in September and that they will hire a large number of HCAs in autumn. They asked each ward manager to spread the word, in order to re-assure burnt-out workers.
* What’s the NHS Pay Review?
We can agree that the pay increase that has been mandated is an insult to workers. But it’s helpful to understand the basis and background of the NHS pay review in order to consider how best to respond to it and struggle for a better deal.
The current pay increase isn’t a ‘pay offer’ and workers and unions are not part of ‘wage negotiations’. So this is a different situation to those for example in some private sector wage struggles we may be comparing this to.
The NHS Pay Review Body (NHSPRB) writes an annual report (you can see them here: https://www.gov.uk/government/organisations/nhs-pay-review-body). It is responsible for recommending pay increases for workers under Agenda for Change pay scales, and the last recommendations were made in 2018 to cover the next 3 years so are up for review this year.
In doing this the NHSPRB takes evidence and recommendations from stakeholders, both government and the unions as well as other organisations including this year campaign group Nurses United. This year, the government’s recommendation was a 1% pay rise. Other recommendations varied, e.g. Unison asked for £2,000 on every pay point, the RCN requested 12.5% for all Agenda for Change staff, and UNITE asked for the higher of £3,000 or 15%. Nurses United also requested 15%.
The NHSPRB then reviews all the evidence, including what the government has said about funding and the financial situation, the labour market situation, vacancies, staff moral and retention, and this year the impact of Covid. On the basis of this they make a recommendation taking all of these things into account, and are recommending a 3% pay increase.
So the unions are now starting to consult on this pay increase, but this is not about whether we accept the pay increase, which is being imposed on us rather than offered, but whether we want to challenge it. Most unions are recommending industrial action, but there seems to be a degree of inertia and a lack of action on the ground in terms of organising to make that happen. They are initially launching ‘indicative ballots’ before deciding whether to seek a vote for strike action. Indicative ballots are not a legal requirement. If the unions did then move to vote for industrial action, this can take place legally if 40% of balloted workers vote in favour of it and at least half of the membership votes.
This process and how it differs from other pay struggles raises some questions such as:
-What difference does having the mediation of the NHSPRB have on the relations between the employer and the workers/unions?
-Although pay review bodies arose out of historical conflicts (such as the wage disputes and strikes of the early 1980s), they now report annually and the proposed increases happen as a routine rather than resulting from workers’ struggle. Has this disconnected and disempowered workers from the sense that we need to struggle for pay and conditions?
-Does the lumping together of a wide range of professional groups and unions in this way dilute their power?
-Has the pandemic influenced NHS workers’ sense of struggle, or their power to do so? Can our response to the pay review be different this year?
* Global supply-crisis hits the NHS
The health sector is a global entity, even if it’s called ‘National Health Service. Our PPE all came from China and currently there is a global shortage of tube for blood transfusion. We are also connected directly to workers in many other sectors, e.g. at the moment there are no flu jabs available due to labour shortage in the transport sector. In our hospital we had no wet wipes for weeks – which makes work really hard!
We could see all this just as nuisances and problems. Or we could see that if we combine our strength with other workers, we could improve our own situation. People only notice the vital work of, for example, truck drivers when the pubs run out of beer, McDonalds out of milk-shakes or hospitals out of medical supply. Workers, whether in care or other sectors have been told for too long that they have to accept low wages, because they are portrayed as being replaceable. At the moment we see that this is not the case!
We also see many struggles of health workers in regions such as India, Philippines, Poland or Nigeria – and many of our colleagues in hospitals and community health centres come from these places! Again, we can see this connection as a problem: ‘Management can replace us with migrant nurses any time!’ Or as a potential: ’Thanks to our colleagues who came from abroad we can learn more about experiences of struggle for better conditions!’
* Strikes at the two biggest hospitals in Berlin
End of August the trade union Verdi has called nursing staff at the state-owned hospital groups Charité and Vivantes out on a three-day warning strike. It’s mainly about staffing-levels, but also about equal pay within the hospital, as many workers are outsourced to subsidiary companies. Currently, the 2,500 employees at these subsidiaries receive several hundred euros less than those doing the same work at Vivantes. The response among workers at all eight Vivantes hospitals and the three Charité campuses to the partial strike has been solid. Supporters constructed solidarity camps outside of the hospitals, organising workshops, cultural events and public actions. The strike has an impact, according to the Berliner Tagesspiegel, Charité has already cancelled 2,000 appointments.
Management at the two hospital groups have reacted with ruthless arrogance towards the strikers’ concerns. Vivantes said it would not accept a collective agreement because the nationwide shortage of skilled workers means a reduction in nurses’ workload would force the company to cut 360 to 750 beds. Consequently, the company would have to dismiss doctors and other non-nursing staff. “The result would be a reduction of 870 to 1,300 jobs and an additional deficit of 25 to 45 million euros,” management claimed. This is clear blackmail! Vivantes blames nursing staff for the reduction of beds and jobs because they refuse to be paid peanuts for too stressful work. Workers cannot rely on the union, though. During the last dispute workers from the subsidiary companies were sold out. In the meantime management at other hospitals throw money at the problem: rather than agreeing to better staffing levels they pay up to 50 Euros an hour for nurses who take on additional shifts, such as in the vaccination project.
On 6th of September 98% of union members at the two hospitals voted in favour of an indefinite strike.
* Coming up: Discussion with health workers in New Zealand
Health workers in New Zealand have engaged in a series of strikes recently, midwives refused to attend elective c-sections, which is quite a step to take! We plan to talk to friends from the local health workers’ network – if you are interested, drop us a line!
Welcome to the second newsletter for a workers-led NHS pay dispute! The various trade unions are slowly starting to inform their members about the consultation – if you are a member, please vote to reject the 3% government pay ‘increase’ decision. Inflation is expected to rise to up to 4% – we might be in for another real wage cut. Here are a few things that we should bear in mind over the coming weeks – until the union consultation closes.
* As health workers we are between a rock and a hard place. The government won’t budge and improve the 3% pay ‘increase’. It will need a lot of pressure to get a better wage. The unions will have to do something to build this pressure, but they are not used to it. They are used to petitioning, symbolic protests, perhaps a demonstration. They are afraid of taking industrial action on a larger scale, last but not least because it might cost them money. At the same time, they have promised members a lot, so they have to show that they are doing something.
* The most likely outcome of this pay dispute is that the unions don’t manage to get enough people to vote in favour of industrial action. This might actually be the best outcome for the union headquarters, as they could say: “We wanted to mobilise our members, but they decided not to pursue the struggle”. They would not have to do much, but would not lose face. According to the law, there has to be one official industrial ballot to take action – as if that wasn’t enough of a hurdle, the unions add two more ballots: the current ‘consultation’ and then an ‘indicative ballot’. It is hard to encourage people to vote three times whether or not to do something!
* The question is also whether the pay question is enough of a motivating issue. Any percentage increase will widen the already stark wage gaps between the different bands. For example, with the current 3% increase that the government wants to give us, a worker on Band 2 will get only about £580 more per year, while a Band 6 will get £1,130 and a Band 9 over £3,000 extra. We have to bring other issues to the table – first of all staffing levels and work stress. Both government and union headquarters will say that this is not possible because this is a ‘pay dispute’ – but if many of us agree that not only pay, but also work stress is a major issue, they can’t stop us.
* We will see a few information stalls and activities by the unions in the coming weeks. Up to now they are timid, on the fringes of the hospitals, e.g. handing out free coffee in the car park. If we want to get more of our fellow colleagues involved we have to bring this dispute into the centre. Let’s call for general meetings of all groups of workers during break-times. Let’s take leaflets and inform others by visiting other wards or surgeries. Let’s not stand at the side entrance, but in the centre of the hospital!
* Short report from a Unison pay campaign activist meeting, South West England
I am a health worker employed at a hospital in Bristol and I took part in an online meeting organised by Unison. Although the meeting was announced as an ‘activist’ meeting, it was mainly a panel of paid organisers who talked. They informed us about Unison’s general position on the pay dispute. They claimed that it was ‘campaigning’ that moved the government to increase the offer from 1% to 3%. This is questionable, but this version of events pleases both sides: the government can say that they ‘improved’, and the union headquarters can say that they’ve already ‘achieved’ something.
There was no real contribution from different union branches, no exchange of ideas about what to do. It was mainly the paid officials telling people what kind of material, arguments and conversation strategies there are in order to convince members to vote. One of the main questions was not discussed: what kind of industrial actions are there apart from an all-out strike? For many colleagues it seems that the only option is to either accept the offer or to go on strike. But a strike is quite a hurdle – there are concerns about the patients, about losing pay. We have to discuss other forms of industrial action which seem easier to take, as a first step. Work-to-rule, for example, where you only perform tasks that are in your job description. Or a collective refusal to work bank shifts. We might need a full-on strike, where only the most essential tasks are performed in order not to risk patients’ lives – but we have to build up to that by trusting each others and our creative abilities.
* Brief workplace report from a mental health worker, north of England
I work in a community mental health team in the north of England. This is a brief report of our experiences over the pandemic and some initial thoughts about how it relates to the pay deal. Like everyone in health and social care, we’ve had a pretty tough 18 months. The pandemic came on the back of a recent change in our team structures, and we were already struggling with staff shortages and constant rounds of not-that-successful recruitment. Like everyone, we had to adapt quickly to the lockdown, moving to remote working, and we were suddenly faced with even more pressure on staff due to team members being redeployed onto the wards and staff shielding. We had the weird experience of GP referrals going down in the full lockdown, but with more people coming to us in crisis, and we all had to change how we worked and found ourselves being even more reactive and fire-fighting than usual.
As things have opened up we’ve started to do more face-to-face working, and starting to see each other and our patients in real life has made work feel slightly pleasant and less surreal. But the staff shortages have actually got worse. I don’t know how many ‘sorry to see you go’ cards I’ve signed in the last few months and we’ve struggled to recruit even into quite senior posts. Care co-ordinators have got caseloads of really unwell patients of 40+ and it’s hard to feel like you’re doing your job properly. We’ve had a load more people off with Covid recently even though vaccinated and others off for mental health reasons, and it’s hard not to feel cross about ‘freedom day’ when we’re still feeling the impact quite severely, even if things haven’t gone as badly as we feared they might.
There’s been no talk at all in my team about the pay increases, and it feels a bit hard to raise as one of the more senior members of the team. I’m sure there’s a few reasons for this: the lack of communication from our unions, the fact we’re split between different professional groups and unions, and the focus of our concerns and stress being about workload and staffing rather than pay and just being completely and utterly exhausted. There’s also the fact that we’re still mostly working remotely, and even aside from that, as a community-based team, we don’t spend that much time together and don’t really have a staff room. I also think we can easily buy in to the ‘hero’ or ‘angel’ culture that’s been encouraged in the pandemic. As well, the fact that our team’s strong identity and sometimes quite an ‘in-group’ mentality means that we have a culture of ‘just getting on with things’, or blaming problems on other teams and colleagues, rather than thinking more widely about politics, services structures and organisation. I’d be pleased to hear from others about the steps that can be taken to overcome this and shift the culture from pay being a bit of a taboo, to being something that’s important to talk and join in struggle about.
* Brief report on resources, capacity and commissioning problems for community mental health workers, South East England, Summer 2021
It feels like workers are having to accept being under-resourced as an ordinary part of the job. The team I’m with has lost a third of its staff in three years, through cuts and workers transferring out or moving on. Community mental health services in England are funded by the NHS and local authorities/councils. A freeze on recruitment just now means council employed workers who’ve left during the last year aren’t being replaced. There’s a promise of some health funding coming to match the gaps, but these things take time. When workers leave it can be months before their posts are covered, even temporarily. In the meantime, work needs picking up. At present, workers can be responsible for up to thirty peoples’ care at one time. On service they should average about half this amount to allow for the kind of flexibility needed for purposeful, responsive mental health outreach. It’s a service set up to work with patients whose needs tend to go unmet in more generic teams, but with less capacity the kinds of care/treatments on offer end up being reduced or restricted, becoming less meaningful. It’s upsetting. Expectations from commissioners and other providers haven’t really shifted with the reduced capacity, so workers are being stretched to meet service agreements they can’t honour with the resources they have.
Commissioning groups monitor the services planned and purchased with NHS funds to check they’re on track and doing what they’re supposed to. This isn’t novel to the pandemic but with more remote/online working this last year, it feels like there’s also been more day-to-day monitoring of how the work gets done. It’s become commonplace to have commissioners copied into emails and involved in more routine aspects of the work, including decisions about direct patient care. This feels like a new development from previous contract-review processes in that there’s now a kind of real time performance monitoring for partner/customer satisfaction. Other services and care providers are encouraged to report and appeal to commissioners’ powers to intervene if they’re dissatisfied with how the team is working. Whilst this probably helps with things like accountability, and maybe even draws attention to the resource gaps, it more often undermines trust and dials up antagonisms between different groups of workers. It takes effort and care to recognise these problems and attend to them in ways that keep us working together.
* Successful campaign by paramedic students in Scotland
We don’t know much about this campaign, but it seems relevant when discussing what collective action can achieve. From the press release: “Today represents a monumental win for student paramedics across Scotland, with our campaign achieveing its goal of winning a bursary equal to that of nurses and midwives. The difference this will make to the lives of hundreds is gigantic. The pressures of food poverty, worrying about rent and mental health will all be eased. This bursary was won because student paramedics came together to fight against an obvious injustice. Our reports over the past year have shown the financial and mental strain completing this course without a bursary takes.”
This book on changes in the working class in the USA seems interesting and insightful. Pittsburgh was once synonymous with steel. But today most of its mills are gone. Like so many places across the United States, a city that was a centre of blue-collar manufacturing is now dominated by the service economy—particularly healthcare, which employs more Americans than any other industry. Gabriel Winant takes us inside the Rust Belt to show how America’s cities have weathered new economic realities. In Pittsburgh’s neighbourhoods, he finds that a new working class has emerged in the wake of deindustrialization.
As steelworkers and their families grew older, they required more healthcare. Even as the industrial economy contracted sharply, the care economy thrived. Hospitals and nursing homes went on hiring sprees. But many care jobs bear little resemblance to the manufacturing work the city lost. Unlike their blue-collar predecessors, home health aides and hospital staff work unpredictable hours for low pay. And the new working class disproportionately comprises women and people of colour.
Today healthcare workers are on the front lines of our most pressing crises, yet we have been slow to appreciate that they are the face of our twenty-first-century workforce. The Next Shift offers unique insights into how we got here and what could happen next. If health care employees, along with other essential workers, can translate the increasing recognition of their economic value into political power, they may become a major force in the twenty-first century.
* International news
Last week there we saw many struggles of health workers all over the globe. Nurses in the Philippines threatened strike action after not having been paid their Covid bonus, while the health minister is embroiled in corruption charges (sounds familiar?!). Nurses are still on strike after several months at St.Vincent hospital in Massachusetts, USA. In France, health workers gear up for a national strike against compulsory vaccination decreed by the government. In New Zealand midwives are on strike and they are on strike for real: they cancelled elective c-sections! In Berlin, Germany, health workers at two major hospitals are getting organised for strike next week, supporters set up a ‘solidarity camp’ with entertainment, workshops and other activities. In Northern Ireland mental health nurses went on a ‘safety strike’, after an increase of attacks and lack of staff. There were also strikes of nurses in, amongst others, Peru, Kenya and India. To follow these news, check out our Twitter feed:
* The various trade unions in the NHS started sending emails to their members to ask them whether to accept or reject the 3% pay offer from the government and whether to take industrial action or not. These consultations end at different times: RCN on the 13th of September; UNISON on the 10th of September; GMB on the 17th of September, Unite on the 24th of September etc.
* Sending out emails to individual members is not enough. Sitting alone at home, asked to vote ‘yes or no’, doesn’t make us feel strong. It also doesn’t reach our co-workers who are not union members – who are the majority. We need assemblies and rallies of all hospital or community ward workers, where we can see each other, give each other courage, discuss what to do. If the unions are not calling for such joint assemblies, we have to organise them ourselves.
* We have to talk about the different kind of problems we have at work and that we want to deal with. Pay is one issue amongst others. The daily stress due to lack of staff is a big one! They push more and more work on to us, from increased documentation to extra patients. This is frustrating for us and the patients, as well.
* We need to discuss how we can put pressure on management and the government. There are all kind of ways to organise a strike in hospitals without endangering patients’ lives. There are various actions that can put pressure on politicians, from occupying public administration to blocking roads. Petitions alone won’t impress them.
* We need independent channels to inform each other what is happening in different trusts across the country. This online newsletter is only one of many ways how we can exchange experiences about the pay campaign, about what the various unions are doing and what not, about what kind of actions we could all take together in order to change things. Feel free to send this newsletters to colleagues and friends and to send your own thoughts and observations.
Our printed newsletter can be found here – if you want us to send you copies, let us know.
* Senior health care assistant, maternity unit, Bradford
Working during Covid was demanding, we had to improvise a lot due to staff shortage. When the government then announced the 1% pay offer people were pretty demoralised, many skilled midwives leave the field. They leave because usually the unions don’t promote going on strike. I have been working here 30 years and we never went on strike. I am not in the union anymore, I was a shop-steward, but I felt the union was more with management than with the workers. Now with the RCN things have improved a bit, but things are still difficult.
My colleagues talk about the pay offer a lot and would be up for industrial actions, but they worry about the consequences. As a form of industrial action you could refuse to fill out certain paper-work while still providing care, but then they tell us that legally you are obliged to do the documentation. It’s hard, we are not making sausages, we care for people. On maternity wards especially it is difficult to do just ‘minimum service’. Workers here are stressed out. Management currently offers a 40% bonus if midwives take up bank shifts, but they don’t do it, because they are over-worked, but also because they feel under-valued and just don’t want to work extra-shifts. We would need an action all over the trust.
* Collective sick-out at (private) Helios hospital in Germany – In reaction to systematic understaffing
Since the beginning of June, management has allowed the admission of more and more patients to the hospital. Patients spent hours sitting in corridors, waiting for beds to become available. The nurse per patient ratio reached from 1:20 to peaks of 1:30. Despite an increase of sickness-related absence of nurses and other health workers, management refused to cap the numbers of admitted patients. Apprentices and support staff had to take over tasks they had not been trained for, such as supervising monitors with patients’ vital signals.
End of July the situation escalated and a whole ward shift called in sick for three consecutive days. Patients had to be relocated to ICU and A&E. Only that moved management to officially declare that the hospital had reached its capacity limit. Surgeries had to be postponed. Management was aware that this was the result of a collective action, and workers celebrated this, even in those departments that had to deal with the relocated patients.
For the time being management has limited the amount of patients per ward, e.g. in cardiology there are currently 25 instead of 53 beds. Management has threatened individual workers with job transferals, but they have to acknowledge that the problem is not going away and that they have to do something about staffing levels. Without the workers, no patients and no money…
* Health worker, Southmead hospital, Bristol
Staffing levels are a major problem. Often you end up having four nurses and three HCAs looking after 33 patients who often actually require 1:1. This is hard as it is, but then the housekeeper is off and they can’t get a bank replacement. We are then expected to do that work on top of our work load. People are rushed into jobs without the proper training, because they don’t have enough staff to do the supernumerary shifts.
Management knows about the problem. For July and August they offer bonus payments for anyone who takes up extra bank shifts. For example, Band 2 are paid £21.05 per hour, Band 5 are paid £31.44. Regarding the pay campaign we had a protest here in Bristol organised by the NHS15 campaign, but most unions were not present, also only very few health workers. The campaign is not visible in the hospital.
* NHS social worker, south east England
How do you feel about the fair pay for NHS workers campaigns?
There are other issues I care more about but I’m broadly supportive of all industrial organising within the NHS.
What do think could help more [social] workers feel able to get involved and show support?
Appealing for more solidarity across the whole workforce. Finding shared areas of concern with social workers and offering reciprocity. Meeting with social work union representatives to formally invite them to get involved and to discuss how this might happen in practical terms. Framing this as a struggle for social justice more widely i.e. by showing the impact of unfair pay on the most precarious members of the NHS workforce & emphasising how this campaign is also protecting the interests of patients who depend on publicly funded healthcare.
Are there any changes you’d love to see in your workplace that aren’t pay related?
Changes to the terms of employment may help to make the workplace more privately bearable in the short term but in my opinion the bigger problem is the alienation from their own labour that so many NHS workers and their patients have come to feel is normal. The changes that I would like to see happening would be seeking to create and protect the possibility for non-alienated care labour within the NHS.
Could you spell the ‘alienation’ or ‘non-alienated labour’ out a bit more?
By alienated labour, I’m talking about what can happen when healthcare work is organised so much around the strategic priorities of NHS England that nothing else seems to matter. One of the consequences of this for frontline workers is that they can easily be made to feel that their labour only has value insofar as it is helping to smooth the way for agendas that have nothing to do with them. The alienation comes from the corresponding (unspoken) requirement that they should not care so much about what they are doing because this makes it more difficult for them to put the interests of their organisation first. This means that workers are withdrawing their affective investments in their own labour at the point that they don’t coincide with the interests of NHS England.
By non-alienated labour, I mean the kind of healthcare labour that doesn’t leave you feeling isolated and overwhelmed with the consequences of having a stake in it. For example, where the realities of healthcare in the NHS are not made into the private concern of individual workers, where workers are not required to do things that don’t make sense to them and where the task of organising healthcare labour is not left to those who won’t be directly involved in doing the work themselves.
* Health workers struggles around the world
During the last two weeks nurses went on strike in Kinshasa and Harare; nurses protested against arbitrary redundancies in Caracas and Hyderabad; hospital workers called for strike in Marseille and Lyon to protest against the government’s Covid laws; in Guatemala health workers joined the general strike; Covid support workers went on strike in Pakistan due to unpaid wages; in Germany and on the Bahamas nurses went on a collective sick-out; and in the USA and New Zealand workers have been on strike at various hospitals and nursing homes…
…so let’s not let them make us believe that health workers cannot take industrial action! For these news and many more follow us on Twitter: healthworkersu1