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Interview with work council/trade union members
(Translated from: Express 5/2021)
For a long time now, trade unions in personal services, care work, in hospitals as well as in day care centers and old people’s homes have been asking themselves the crucial question: How do you go on strike when other people depend on your work, or even when human lives depend on your own work?
At an ambulance service on the Swiss border, which is covered by the “DRK (German Red Cross) Reform Collective Agreement” negotiated between ver.di (service trade union) and DRK, the workers found a creative solution: They work, but while the collective bargaining dispute was on they refused to do the bureaucratic work that is necessary for the billing of services (e.g. with health insurance companies). Karin Zennig talked with two of the works council members involved in this “paperwork” or “billing strike”.
How did you decide to go on paperwork strike? Why did you resort to this method and not walk out ‘normally?’
Mira: The idea came from ver.di. So far, the paperwork strike has only taken place within the emergency services. Since it is almost impossible to go on strike when you work in emergency rescue services, another method was sought to draw the employer’s attention to the grievances and to strike without suggesting to the population that human lives could be in danger. This is the best method for us. After all, we don’t want to harm the population by not manning a rescue vehicle, but to put pressure on the employer – so we work and are thus entitled to wages, but the employer doesn’t get any money from those who pay for the services. By the way, we now talk about ‘billing strike’ instead of paperwork strike, because we don’t want to give the impression that we are only ‘striking on paper’.
What are the important issues? What are you demanding?
Dirk: In general, better wages, working hours and workplace arrangements. For example, it is always an issue that not all working hours are paid in the rescue service. Nationwide, it is common that for twelve hours worked, only 9.75 hours are paid. This means that every full-time employee in the rescue service works more than two hours ‘on a voluntary basis’ for every service each day. Under collective bargaining agreements, this is called ‘extended working time’ – legally, the employer thus circumvents the payment of ‘on-call time’, which would have to be considered working time according to rulings by the Federal Labor Court and the EU Court of Justice. For the first time in the 2018 collective bargaining dispute, we decided to go on a paperwork strike.
And how does such a ‘billing strike’ work?’ How is it different from a ‘normal strike?’ How much courage do you need to participate in a paperwork strike?
Dirk: In a paperwork strike in the ambulance service, everything that concerns billing is omitted. Normally, after a rescue or emergency operation, the data of the operation (location, transport destination, crew) with the data of the patient (name, address, health insurance, etc.) are sent to the billing office. A so-called transport bill is enclosed for this purpose. This certificate confirms that the transport has been carried out and thus provides the basis for billing. However, this ‘office activity’ is not actually in the paramedic’s or ambulance crew’s original job description. To refuse to perform this activity means that insurers aren’t billed, therefore they don’t pay out, and the DRK doesn’t get reimbursed.
Mira: I don’t think it takes that much courage, it just takes everyone sticking together and participating. I think it would be harder to have a strike by not staffing a rescue operation than just not billing.
How does the employer respond to that? What are their strategies?
Dirk: The employers are always trying to stop industrial action with targeted intimidation. In the last but one round of collective bargaining, the employer openly communicated that in the event of a strike, payment claims against the striking workers could be expected and that everyone should think carefully about whether they would take this on themselves.
Mira: In a well-organised company, a paperwork strike like this can quickly cause tens of thousands of Euros in damage, and employers naturally don’t like that. Here it is always good and important that we know that our union is on our side and that it informs our colleagues about reaction strategies and our rights during a strike.
Even in a paperwork strike, it’s about acting together. How do you organise the collective momentum, which gives the individual the necessary courage? How do you arrange going on strike? Who knows when they do what and why?
Mira: Yes, of course everyone has to participate. There are a lot of us in the union, so that’s not a problem. We do a lot of group chats and talk to each other personally. Everyone explains to the others what it’s about and how they feel about it. And when it’s not a pandemic, we meet with our union secretary and discuss what we need and how we can move forward together.
Is this method transferable to other areas? What positive or negative experiences with the strike and the organisation or reactions have you had with it that you would like to pass on to other colleagues?
Dirk: You mustn’t lose sight of the fact that this method is the most effective in bringing employers to their knees. Since workers don’t stop work, they continue to be paid in full and all other operating expenses continue as well. But the incoming flow of money is interrupted. So, it’s possible that an employer is driven into bankruptcy quite quickly. Those most responsible for strikes, like union reps or shop stewards should, if in doubt, always keep an eye on this situation and intervene in time.
Mira: I’m just imagining, for example, if a waiter goes on strike by bringing the food to the guest, but never issues a bill afterwards. Well, our employer was not very pleased, neither by the strike nor by the actions themselves. They’ve been used to their employees never raising their voices for years, but they have been doing so more and more often and louder and louder in recent years. In my opinion, the employers are also dealing with this in the wrong way. They make us look as if we have outrageous demands instead of finally valuing these professions more. What is very positive and resonates far and wide is the cohesion amongst us and the feeling that we can achieve something together.
(Picture: Recent rebellion of hospital workers in Argentina)
This is a longer version of a leaflet that we wrote for the current pay campaign in general and the day of action on the 3rd of July in concrete. If you want us to send you copies for your local protests, please contact us at: email@example.com
We don’t have to tell you anything new about the situation. We all lost 10% pay in real terms since 2010, the 1% or even 4% pay offer is a disgrace, inflation is rising. There is enough money floating about, but it ends up in the wrong pockets, of this or that CEO or investor or friend of No.10. Where the money ends up, whether in our or their pocket, is a question of power. How can we develop our power?
Power is different from appealing or lobbying. They won’t give us more money because we did a great job during the pandemic and people clapped for us. They won’t pay us because we are kind and gentle souls. They won’t pay us because this or that MP puts a word in for us or we have 100,000 followers on twitter. They won’t feel enough pressure if we just go on another one-day protest march.
The only chance we have is to put real pressure on. A lot of work we do creates profits for trusts and indirectly for outsourced companies. We can go on strike, other health workers around the globe do it every day, without putting patients’ lives at risk. True, we don’t work in a car factory or bank call centre, we care for sick people. But we ourselves know best which work is immediately necessary to save lives and which work isn’t.
There are other ways to put pressure on too. In Argentina, health workers recently mobilised other working class people and together they blocked access to the local oil fields, demanding higher wages and better health services for everyone. We might not find an oil field nearby, but an Amazon depot might do or the morning rush-hour into the financial district!
Any action requires a degree of confidence and unity. Everyone will tell you that this is lacking. We have to find ways to organise ourselves, which help us regain trust in each other and ourselves. Often we can find some collective spark when we look at how we worked together during the first months of the pandemic. It was us together who got us through those days, while management and politicians were fumbling around. Together we know how to work with substandard equipment and unclear guidelines, we kept the show running. On some wards, in some hospitals our fellow workers enforced health and safety standards, an increase in (bank) staffing levels and bonus payments. That is a start.
The way work is organised and even how the unions are organised creates divisions. Divisions between different professional groups, various bands, in-house and outsourced workers, this union or that union. We need to form assemblies and open meetings on a hospital level, where all workers can come together and discuss how to go forward. We need to think about how we can do this in the community too, where we can be even more dispersed and disconnected from our fellow workers.
Health workers have done it before, we can do it again. Even before the existence of social media and mobile phones, health workers in France and Germany in the late 1980s formed such assemblies and connected them in a national coordination – see the short article about this on our website. It was not the various union headquarters who decided what the struggle should be for and how it should be conducted, but the health workers themselves.
We already see some problems with the union divisions. In Scotland, Unison recommended to accept a 4% pay offer, while other unions refused. What kind of signal is this to the politicians and managers?! Yes, we demand £2,000 annual increase officially, but if you throw us a bone, we take it?! The RCN might be willing to mobilise the nurses, but they are not too interested what is happening to healthcare assistants, porters or cleaners. There have been many strike actions of support staff – from porters at Cumberland trust to lab workers at Blackburn hospital – but these struggles remained isolated, not just within their own hospital, but even within their own union. We need forms of struggle that bring us together and allow us to discuss where to go.
We have to use this mobilisation to raise all the other concerns we have. It’s not just about the money, it’s about how we work and live our lives! The constant stress and rushing, because there is too much work. The hierarchies that stop us from really working together. The way that this makes us sick ourselves. The fact that with all the stressed health workers and the cut in money hospitals become places where patients get sicker, rather than better. We can see that most of the patients have been made sick by this stressful, depressing society, where it’s dog-eat-dog rather than living together. Hospitals and clinics are treated like the garbage bins for this society. We can raise all this together with the patients!
What can we do here and now?
All this might sound pretty big, but workers have done it before and they are doing it elsewhere. We have to learn from these experiences and share our own stories of small steps of resistance that we take ourselves. You can find some examples below.
All this won’t be done in a day. But we will need these kind of structures for the future. We need more solidarity and support in our lives. We, the people who keep things running, keep people warm and fed and care for them should run the show. We need working class power and control over the means for a better life for all.
If you feel similar, get in touch! We are a network of workers in the health sector. We are not yet another organisation who wants you to become a member, but want to discuss our experiences at work and in struggle together. We want to find ways that help us and our fellow workers to gain control over our own struggles.
The following reports describe small and large actions taken by health workers. Some actions have been taken by local workers, some abroad. Some were taken in the past, some today. However small the action, we can learn from them. We always want to hear about your experiences.
Recent local actions…
In this particular ITU, some of the staff saw that the use of agency nurses was increasing. There had also been some concerns that paperwork wasn’t always being completed by the agency staff and, therefore, permanent staff were also having to pick up more work. A nurse put together some costings that proved if the trust were to increase the rate of pay for bank shifts for their permanent staff, then the uptake of these shifts would be greater and the need for agency staff would be less – with an overall cost reduction. This was agreed on by management and staff began to pick up more bank shifts.
This went on for a few months. But then management decided they would no longer be willing to stick to this pay increase and the bank incentives were removed. As a result, ITU staff decided to cancel their bank shifts on ITU as a protest against the removal of the incentives. The result of this was that there were more agency nurses needed and also gaps in the rota. This forced management to increase the pay for bank ITU staff permanently.
There are around 250 permanent nurses in intensive care, with about half of those regularly picking up bank work (one shift a month or more). This short report raises important issues for our current struggle for higher wages. The action of the nurses shows that management reacts to collective pressure from below, even if only a small group of workers are involved. It also shows that we have to overcome a few barriers to broaden the struggle. We see the division between the local ITU nurses and the agency staff – the ITU nurses want to prove that they are more ‘cost effective’, while some of the agency nurses might not have been interested in the general work atmosphere, as they ‘stay only for a few shifts’. We need to address and overcome these divisions.
The trust where I work employs over 500 apprentices who earn only 75% of the band 2 wage, but actually do pretty much a normal job. Most of the stuff we need to learn, be it as HCAs or housekeepers, is learnt on the job. Because the government supports apprenticeships and because they have to justify the 25% pay cut, they say that 20% of our working time is ‘off-the-job’ learning. In reality we’re told to write down any odd thing as ‘off-the-job’. If someone tells you how to make toast or hold hands with someone on the dementia ward, just write it down as ‘off-the-job!’ Because the wards are so busy, even during nights, they ask you to fill work books in ‘in your own time’. If you complain and say that you might leave the scheme, they say that you have to pay back the apprentice wages! People who had years of experience working as health carers, but didn’t have the right ‘certificate’ were forced to enter the apprenticeship. It’s basically a scam to cut your wages by a quarter for a whole year or longer. Up to now, everyone seems to be playing along. We need a meeting of apprentices to discuss the situation!
In 2018, a UK homeless mental health team campaigned against cutbacks by bonding together with local hospital & community services. Their tactics included workers gathering testimonies to give to decision-makers to show how cuts would be harmful. The coverage in a national broadsheet drew professional, academic and community support, which in turn led to commissioners/leaders having to defend the cuts in a public deputation. These actions helped offset the majority of cuts and assisted workers to share their experiences and support with others facing similar challenges across a wider mental health service.
For years, the cleaners, caterers and porters at St. Mary’s Hospital in west London, had been treated appallingly by French multinational Sodexo. Low wages, unpaid overtime, only the legal minimum sick pay. In October 2019 that began to change. As a group of 200 workers went out on what would go on to be one of the longest strikes in NHS history. Their demands were simple: to be made direct employees of the NHS and to enjoy the same pay and rights as other NHS staff. They were told by management that this was impossible. But after just three days of striking they won what they had also been told was impossible: the London Living Wage. But these workers would not allow themselves to be bought off. They persevered, together with their union UVW. They occupied hospital corridors, and on the 9th and final day of strike action stormed an executive board meeting to finally make the NHS managers listen to the horrors of working for Sodexo. The victory resulted in 1,200 workers across five hospitals being made direct employees of the NHS with each of them receiving a pay rise of several thousand Pounds and vastly improved terms and conditions.
In February 2021, the public workers trade union (ATE) and the local government in Neuquen agreed to a 12% pay increase for health workers. Workers were angry about this deal, partly because of high inflation, but also because the union leadership had ignored the hospital assemblies who wanted to refuse the pay offer.
On the 2nd of March workers from hospitals of the whole region met for a ‘general assembly’ in the main public square. They decide to go on strike without waiting for permission from the union. They demand a 40% pay increase, permanent contracts for agency workers, and better health and safety conditions. Their protests and strikes were joined by local teachers. When the local government offered an insulting 3% extra pay, workers and supporters started blocking the access roads to the main oil and fracking fields, to put an additional economic pressure on the state. They also blocked roads to the important tourist resorts. The blockade of the oil fields lasted for three weeks, and many truck drivers joined in support. The oil companies tried to fly workers in with helicopters, but had to close many oil wells.
After 55 days of struggle the government agreed a 53% pay increase, staggered till end of 2021. Workers say that they would never have been successful without the support of other working class people, such as teachers, factory workers and unemployed. These people hadn’t forgotten who cared for them during the pandemic and joined the street blockades. The final assembly, which ended in a music festival for everyone added another demand for future struggles: the introduction of the 6-hour day.
Workers at NPK, a group of five hospitals in East Bohemia comprising over 5,000 workers, are in the process of organising their struggle. It is difficult: five hospitals mean different working conditions, wages, different work organisation, managements tactics. The initial reason for the struggle has been meagre Covid-19 bonuses, but this issue just opened the door to others: working conditions, wages, power hierarchies, repression by management. Petitions were circulating, sometimes signed by single, sometimes by several wards.
ICU units and anaesthetic nurses took the lead. Individual nurses and wards contacted the independent ‘Nurses’ Initiative’, which then got everyone in touch, at first over Zoom, then through direct meetings. The struggle was first discussed during a general meeting by one hundred workers at the beginning of May 2021. At the meeting, they decided to analyse each department where workers were present and see how workers could apply direct pressure on management, primarily through ‘work-to-rule’. Management is vulnerable to this tactic, because they compensate the lack of staff by breaking their own rules.
Workers had already gathered experiences with this method of ‘work-to-rule’ at KKN hospitals in West Bohemia during a long struggle in 2017/2018. The rebellious workers forced the local government, which is the owner of the hospital, to raise wages. This resulted, for example, in a 30% pay increase for experienced anaesthetic nurses between March 2017 and March 2018.
The struggle at KKN (as well as now at NPK) was led by Nurses´ Initiative, an independent self-organisation with their own workers’ newsletter founded in 2016. It was led outside of the official trade unions and against them in necessary moments.
For the last ten years, a network of workers at a hospital in Dachau have been organising themselves independently. They organise their own meetings and a hospital newsletter, without support from the mainstream unions. They took various actions together. In 2012, management wanted to cut night-shift staffing levels on several wards, by introducing a 4-hour shift of nurses who just hand out medication. Management tried various divide-and-rule tactics, but wards supported each other and refused the new shift-model and sent a protest letter to management and the health authorities. They did this in opposition of their official representatives in the ‘works council’ (workers’ representative body).
In 2014, after the takeover of the hospital by the Helios corporation, management wanted to force workers to be ‘on call’ on two of their days off each month. This would have led not only to extra unpaid stress, but also to job cuts in the long run. Again they tried to introduce ‘test runs’ on a few selected wards, but wards coordinated with each other and all of them refused.
In 2017 the trade union called for a strike during the collective contract negotiations. The independent network managed to elect 90% of all strike committee delegates, which meant that all workers, not just union members, could be in the strike committee. The union initially didn’t want any pickets or noisy protests, but the delegates organised them anyway. They organised three spontaneous protest marches through town. They also marched to the trade union office to put pressure on the main trade union secretary during his visit, because they feared he would settle for a lower pay increase.
700 nurses at Saint Vincent Hospital in Worcester, Massachusetts have been on strike since the 8th of March 2021, demanding safe staffing for patients and higher wages. The private hospital company Tenet, has spent millions of dollars on the strike, including hiring replacement nurses and paying the Worcester Police Department $30,000 a day to patrol the picket line. The dispute has rumbled on for a long time, but Covid was the final straw. There was an absolute lack of staff.
So the nurses themselves organised the recovery room into an intensive care unit so all the COVID patients who needed critical care nursing could go to the ICU. In other hospitals in the US, workers went on spontaneous strikes and sit-down protests to enforce better PPE and more staff, too. Since Covid, there have been nearly a dozen health workers’ strikes in various private and non-profit hospitals. The workers at Tenet are committed, but they are increasingly isolated. The trade union Massachusetts Nurses Association (MNA) has around 23,000 members in the whole of the USA, but up to now they haven’t called any other workers to protest or go on strike in solidarity with their fellow workers in Worcester.
Struggles in the past…
In 1982, there was a pay dispute within the NHS by health workers including nurses, porters, clerical and auxiliary staff. Members of the COHSE and NUPE unions demanded a 12% pay rise, rejected by the government. Strikes began in May ’82, and became the largest dispute in NHS history. It consisted mainly of woman workers and has been largely ignored in the years since, unlike other disputes such as the miners.
During the strike, only emergency work was performed. New strike laws introduced in 1982 made secondary picketing or solidarity strikes of other workers illegal. Other unions ignored the law holding a 1 day sympathy strike, from shipyard to factory workers or schools and leisure centres across Britain. The largest ‘day of action’ on 22nd of September saw strikes closing most pits, disrupting the ITV network, automobile production and post offices. All this solidarity despite its illegality! However, the dispute was largely overshadowed by the British and Argentine bosses war in the South Atlantic, which gained predominant media attention. In the end, the negotiations became dominated by the RCN scab union, and the leaders of COHSE and NUPE lowered their demands. Although not all health workers got pay rises, some nurses got a 14% pay rise. However the government soon began privatising auxiliary services soon after.
In autumn 1988, the mainstream unions called for a symbolic strike and protest march of health workers. After the national demonstration, around 2,000 health workers met to form an independent coordination. The next strikes were called by this coordination directly, rather than the unions who were playing catch up.
Also, only 5% of health workers in France were members of unions at the time, so most of the strikers were not part of the unions in the first place. Local hospital assemblies and regional coordinations were the strike movement’s backbone. At the time, the workers had to organise all this without Facebook, Zoom or WhatsApp!
A typical pattern developed to make sure that the hospital assemblies remained the decision-making bodies, but didn’t get isolated: after each day of action on Thursday, the strike continued on Friday so that meetings could be held at the hospitals and delegates elected to go to the national coordination on Saturday. The demands were similar to our’s today: substantial pay increases and better staffing levels. Most of the demands were met by the government.
But there were also problems. In many cases the coordinations didn’t overcome the professional divisions. Only later on did nurses and support workers struggle together. The strike remained largely limited to the public sector hospitals, although the strikers demanded that the demands were also fulfilled in the private sector. While in Paris and other big cities, up to 90% of all nurses followed the strike call, numbers were much lower in the rural areas. The government also tried to split the coordination and offered some delegates advisory positions on the government health board. Still, there is a lot to learn from the experience back then. Shortly after the coordinations were formed in France, hospital workers in Germany formed similar structures. Even the nurses strike in the UK in 1988 can be seen as part of this international learning process.
We translated this text from the late 1980s because it can still serve as a reference-point when searching for new ways that we can organise ouselves as health workers from the bottom up, rather than waiting for orders from the top. The experience of hospital and health workers assemblies in Germany took place in a wider international context, inspired by assemblies and coordinations in France – we translated a text about these coordinations recently. On the hospital level we are divided by bands and different union affiliations – demonstrations alone will not overcome these limitations. We need open assemlblies for all workers, where we decide together about the next steps of our struggle. We can learn a lot from workers in other countries, e.g. from the recent health workers rebellion in Argentina, where workers and supporters blockaded the oil fields in order to increase pressure on the government without putting patients at risk.
The mobilisation in the ‘white factory’
It looked like a (western-)European-wide chain reaction: in early 1988 nurses and hospital workers went on strike in the UK. In September and October nurses and hospital employees took the streets in France. In January 1989 industrial action shook hospitals in Belgium. In the Netherlands it was initially the doctors who walked out in December 1988,but, over time, care workers joined in and an action committee “Hospital and care workers in revolt” was formed. In Italy, the unions were organising strikes in the health sector. In May 1989 50,000 care workers in hospitals and nursing homes went on a warning strike in Germany, called for by the OTV (Public Services, Transport and Traffic) trade union.
‘Care emergency’ from above…
In summer 1988 a German doctor publicly proclaimed a ‘care emergency’, because he wasn’t able to find workers and, owing to poor wages and working conditions, retain them. Since that declaration, the topic was taken up by the wider media, and a movement was beginning to form. In autumn 1988, independent groups of care workers had organised smaller protests, and it was in Bavaria where these protests attracted the most public attention. In November, 10,000 people took the streets in Munich. The demonstration was organised by the OTV and the Working Group of Care Workers in Munich, which was dominated by works council members and head nurses or matrons. The professional association DBfK (Deutscher Berufsverband fuer Pflegeberufe / German Association for Care Professions) joined later on. The association became more radical in the course of the struggle and was joined by independent (local) groups. The association was able to mobilise 8,000 workers to a protest in Duisburg and in March 1989, 20,000 people came to a national demo and rally in Dortmund. At many hospitals lower management supported this mobilisation, gave people a day off or changed shift-schedules and organised busses. Management hoped that the professional association would be able to keep the mobilisation under control.
…and mobilisation from below
Management was concerned because the atmosphere on the wards became more explosive. The discontent about stress at work and the low wages that had aggravated workers over the recent years were massive contributors for the development of a consciousness for action. In 1985/86 the employers tried to drastically cut the wages of apprentices. The OTV was confronted with massive protests by apprentices, who felt that the union was doing very little to represent them. We heard frequent news about unofficial actions. Workers were trying to form rank-and-file groups on ward level or hospital-wide assemblies in Frankfurt, Cologne, Kiel, Bremen, Wuerzburg, Freiburg, and many others. Meetings about the recent strike movement in hospitals in France or the ‘care emergency’ managed to attract 50 to 100 people at short notice, and there was a general enthusiasm behind the movement with workers seeking to link up and become active. There was a clear desire amongst a great many workers to talk about their own situation at work and to break through the isolation. The meetings resulted in quickly mobilised demonstrations and public actions. In January and February these new meetings organised the first bigger demos in Frankfurt, Cologne, Kiel and a few other towns. Given that the participants organised these demos themselves they were lively and creative. Without the OTV or the professional associations present there was no one who would hand out pre-fabricated banners or signs. People brought their own slogans, they brought hospital beds or music instruments made out of bed pans. There was a strong urge to keep the institutions from taking over the control of the protests.
Problems of organising and struggle…
The independent groups and assemblies had very different characters, depending on town and hospital. In some towns the union didn’t turn up at all, at least not initially. In other cases, the groups oriented themselves towards the collaboration with the professional associations early on. In some cases the mobilisation was driven by hospital-based groups, and in others by assemblies that didn’t have deeper, collective roots in particular hospitals from the outset, but gathered the discontented from various hospitals and care homes across their regions. This was perhaps one of the main reasons that various problems emerged in the further development of the mobilisation.
The main question remains throughout all of this; how can we better organise ourselves taking effective actions in struggle? In the discussions it became clear that our only effective way to exert pressure is the refusal of work. On an individual level this was done by thousands of people, who decided to leave the job, apprenticeship, or study course that they were on. ‘Work to rule’ or ‘Strike’ were therefore the slogans of the day, in an attempt to build more collective responses. One issue, however, is that when it came to, ‘work to rule’, fundamentally different perspectives and ideas began to emerge. For some ‘work to rule’ is an effective weapon if it is extremely difficult to go successfully go on strike. For others – like for the professional association – ‘work to rule’simply meant only doing the work that was designated as tasks in the “professional category”, which was drawn as a distinction between the more managerial tasks (professional) and the ordinary day to day of the “ordinary” carer.. Clearly this meant a breakdown in solidarity, as it drove a material wedge between the workers.
Accordingly the groups that emerged in various hospitals in the country have different ideas about themselves and their roles. They either saw themselves as an action group, which quickly leads to a collaboration with the OTV, if only in order to get (legal, material) backing. Or they tried to achieve immediate changes in discussions with the lower management – and therefore enter into dialogue with the ward and department leadership and doctors and quickly become dependent on them. With the assemblies that gathered people from various hospitals the problem is less that they became dependent on existing ruling structures, but without structures based in the hospitals they were never able to go beyond ‘public protests’, and so were limited in their capacity to force real change on the bosses. There was also a danger of becoming ‘hyper-active’, becoming nothing but a channel for pent up discontent, which while understandable, lacked the potential for the transformations in the labour process that the workers were demanding.
It was therefore easy for the assemblies to take on a ‘representative role’, a kind of trade union substitute that speaks ‘for’ the people, raises demands ‘for’ them etc. Due to the hostile attitude of the OTV towards the assemblies, which saw their (union) monopoly of representation at risk, the assemblies ran a danger of becoming confined to a competing role, which they themselves didn’t want to play. In some towns the assemblies saw themselves as an opposition or caucus, within the union right from the start. The claim to representation expressed itself in the fact that ‘demands’ were attributed way too much significance by some groups, in particular during the effort to coordinate on a national level. As soon as you raise demands the questions ensue, “Demands by who? For who? On who?” and “Who negotiates?” The examples of the recent strikes in France and their “National Coordination” was given a role-model character by organising workers, and were seen too uncritically. On one hand it is entirely fair to say that only the existence of the Coordination made it possible in the first place that a national strike could even possibly be launched independently from the passive unions. Here in Germany, as well, two meetings for a national coordination in Cologne have resulted in independent actions (e.g. the day of action on the 15th of April). Though the French example should also serve as a warning: by becoming a representative body for a particular profession (nurses) and not mainly a coordination of practical struggles, the coordination increasingly became a union substitute. The demand for 500 Deutschmark for all, which became pretty widespread in Germany in ‘89, showed potential to serve the purpose to express discontent with the trade unions’ ritualistic bargaining procedure, and for workers to express solidarity with each other regardless of rank or job title division. As a demand for a fixed amount, rather than a percentage increase, the demand opposes the divisive games of ‘performance benchmarks’ and wage categories. However, it is important to bear in mind that the demand didn’t replace the practical and active unity in struggle. More important than any demands and their details is the practical step to develop our power together.
Attempting to re-orientate our assemblies
The first phase of large assemblies with their combative atmosphere and lively discussions came eventually to a halt. Either people became disillusioned, and left, because the assemblies could not solve the problem of how to organise the struggle at their particular workplace, or the conscious (and initially correct) re-orientation towards organising in ‘one’s own’ hospital rendered the assemblies less significant. There was also the fact that the time this began to happen, the OTV had begun to take complete control over decisions that determined the course of events. Under the pressure of the independent mobilisation, they were forced to recapture the leadership position by calling for ‘warning strikes’ in the concurrent round of collective bargaining. In many towns people realised that there was a lack of more concrete considerations about the character and goal of the assemblies. In a situation where there were hardly any rank-and-file structures at all, the assemblies initially fulfilled the task of getting people together and of encouraging them to take the first round of actions. The problem is that it is obvious that they didn’t create the possibility of more permanent organising that could have deepened and developed throughout the course of the struggle. Where they took place over a longer period of time, they were characterised by intense fluctuations in their aims, targets, demands and political orientation. What remained, though, were small cores, that continued with the task of the exchange information and coordination between the different hospitals.
(Up until this point, the original article has been adapted into a past tense following its translation and edited to be more coherent without changing the content of the piece. The following paragraphs are as they originally appeared in the translation. The choice has been made to leave them as they are, as they capture a crucial moment in the struggle, as well as the recommendations of those involved which we tend to agree with.
It is moments such as this, where a struggle seems to be at a crossroads where one path leads to transformation and another leads to a retreat, that is most crucial to reflect on the experience of those who came before us.)
Where are we now?
At the moment people in many cities will be in process of discussing a balance-sheet of the mobilisation. Given the general situation in Germany, with its tradition of ‘social peace’, the mobilisation was significant, in particular, because it originated in a sector where the simple act that wage work is exploitation is still covered up by ideals of ‘helping’ and ‘sacrifice’. The mobilisation had elements of independent activity from below. In particular a union like the OTV, which is used to send the battallions into (symbolic) warning strikes from above, has been noticeably shaken. The current warning strikes in hospitals and care homes are a play with fire: on one hand they want to remain in control, on the other hand people are having their first experiences of strikes (which might bring about unforeseen results). Where the strikes were accompanied by independent activities they actually interrupted the business in hospitals – in other cases strikes were hardly noticeable and the OTV hyped them up in the media. The fundamental problem of strikes in hospitals remained unsolved: in most cases the strikes only led to a temporary postponement of work. Unfinished work was in some cases completed by working overtime.
After the collective bargaining is finished the problems for an independent mobilisation and ccordination will return. The predictable result (upgrading by one wage band maximum) will disapoint many and the old problems regarding working conditions will remain. The conditions for a new wave of mobilisations after the summer are given. Then it won’t be possible to address the unions with our own demands. In autumn we will see if we manage to organise ourselves independently in the hospitals and on the wards and to develop new forms of activities.
For a hot autumn!
Here in the UK we face a difficult situation in the health sector, people are tired, they survive on low wages, they fear changes such as privatisation. We haven’t found our own ways yet to do something about this. Health workers in Argentina don’t have it easier than us. Their conditions are similarly bad, if not worse. But they have found ways to make themselves heard. Read more about this below. If you are interested in discussing our situation as health workers and the current pay campaign, get in touch: firstname.lastname@example.org
What started as a health workers’ dispute has turned into a regional uprising. Since early March, health workers throughout the province of Neuquén in Argentina have been staging unofficial strikes and roadblocks, demanding a pay rise higher than the miserable deal agreed by the government and the unions. They also demanding better working conditions to face what is expected to be the second wave of coronavirus in Argentina. The health system is not up to the task. Increased layoffs of critical care nurses and emergency paramedics over the past year have exacerbated staffing shortages. This dispute has turned into a bigger movement, and a self-organised one at that. Workers have been setting up a strike fund and holding open meetings at the hospital entrances. After being ignored, the movement has escalated their tactics by using roadblocks to obstruct the province’s oil and gas production.
Background of the dispute
In December 2019, the provincial government froze public sector wages. This meant a 26% loss of purchasing power for health sector workers in the midst of the 2020 pandemic. The vaccination campaign, which began in early 2021, is slow to get off the ground while Argentina is caught up in the second wave of the pandemic.
Why has it kicked off now?
On February 24th this year, the provincial government offered a 12% wage increase to health workers. On February 25th, the union’s grassroots assemblies in about 20 hospitals and health centres rejected this proposal. Union General Secretary Carlos Quintriqueo ignored this vote, and on Feb. 26th, the union leadership accepted the government’s deal. This fierce betrayal of union (ATE) representatives was the straw that broke the camel’s back.
On March 2nd, a large inter-hospital meeting of health workers was held in the centre of Neuquén, the provincial capital. They decided to demand that wage negotiations be resumed, a 40% increase for 2020 and an adjustment in line with inflation for 2021. They also decided to coordinate their demands with the teachers’ union, ATEN, and to draw up a joint action plan. ATEN had rejected the same wage proposal a few days earlier, and decided not to resume classes on March 3rd.
At the same time, various conflicts were spreading in the region. Social movements blocked rural road bridges and other points for an increase in support programs; schools throughout the province made demands of the state; and the feminist movement took to the streets against the femicide of Guadalupe Curual in Villa La Angostura. On March 10th, self-organized health workers, opposition to the ATEN union leadership, other public sector workers, workers in the self-managed tile factories, and social movements came together in a demonstration that ended at the main government building. On March 12th, health workers with the union of justice workers (SEJUN) blocked the bridges between Neuquén and Cipolletti. Meanwhile, ATEN maintained a protest camp in front of the government building. There was still no response from the political side.
On March 16th, the provincial government agreed to add 3% to the wage increase, for a total of 15%. At the same time, the health workers rehearsed a first blockade of the oil route, the roads through which the project of Vaca Muerta is carried out. (Vaca Muerta is an oil shale deposit where they’re fracking). The government continued to refuse to meet with the self-organized workers. ATEN’s union leadership pushed through the approval of the wage proposal, even though it meant a significant loss of wages. On the same day, the Cerámica Neuquén tile factory (which had been taken over by the workers*) was again threatened with eviction and auction.
On March 24th, (the anniversary of the 1976 coup), thousands again took to the streets. In addition to the usual demands for commemoration, truth and justice, health was big on peoples’ agenda, demonstrating the broad legitimacy health workers now had amongst the wider population. More roadblocks, this time to famous tourist destinations, resulted in more clashes. The traffic chaos and growing criticism of a continued lack of response from the government emboldened health sector workers to expand their struggle further.
Oil and gas blockades
The Neuquén area is known for its oil and gas industry. On April 7th, a series of indefinite blockades began at strategic points along the oil route, focussing on Añelo, the neuralgic centre of Vaca Muerta. Through the roadblocks, workers have been mainly targeting the trucks transporting fuel from the Vaca Muerta refinery, while letting the rest of the drivers pass. The blockades have made it difficult to drill new wells, forcing the closure of smaller wells, and causing problems at processing plants that threaten Buenos Aires’ gas supply.
As the government continued its silence, the number of blockades increased to twelve by April 10th. For the last two weeks, 30 roadblocks have paralysed the activities of the petroleum industry in Vaca Muerta.
In parallel, a meeting was convened with social movements, unions, parties and local organizations in the city of Neuquén at the Castro Rendón Hospital, the largest hospital in the province. A few hours after this meeting, the state energy company of the province, EPEN, cut off the electricity to the worker-run Zanon-FaSinPat tile factory.
At first, the authorities had maintained that pay rise negotiations would only take place with the unions and refused to meet with the strikers. Finally, after weeks of unofficial actions, the provincial government agreed to meet the protestors but after a couple of meetings, which the workers considered unproductive and a waste of their time, they decided to leave the negotiation table until there was an acceptable pay rise proposal from the government.
“We left our answer on the table and told them that we are not going to accept any more teasing, as they did yesterday (Friday 16th) when they kept us for 9 hours in sterile discussions. When they have a proposal for an increase in the basic pay, they can call us and we will sit down to discuss it. In the meantime we will continue to hold roadblocks and deepen the measures.” said one of the representatives of the workers, after last Saturday’s meeting.
Throughout all this, the Mapuche communities in the Añelo area have been joining the pickets. The situation with the truck drivers has gone from conflicts and counter-pickets to solidarity. Workers have joined in solidarity and stayed outside the Ciudad Judicial where the negotiation meetings were held.
Meanwhile, almost all the union leaders not only do not support the strike but even openly attack it, like the leader of ATE Neuquén. The union leaders aligned with the Kirchner government, who went so far as to consider that it should be repressed, forcing all the sectional delegates to sign this declaration, which some of them denounced.
Despite the position of the union leaders, on the roads and in the streets of Neuquén, there is massive participation of health workers and massive support of teachers, as well as the active support of various militant unemployed movements. In addition, most of the oil workers and truck drivers appear to be getting closer to the health workers, despite the significant physical and monetary wear and tear that being stranded on the roads causes them on a daily basis. Some helped to block supply products for fracking, and have been maintaining food supplies.
Last week ended with a strike by the teachers’ union ATEN and the judiciary union SEJUN, which issued a joint statement with various unions at the Universidad del Comahue. It was a strike in solidarity with the health sector. The union leaders, under pressure from their own rank and file and large public support, could no longer stay out of it.
In a recent statement, the workers declared that: ¨(…) In the face of any offer from the government, it will be the assemblies of the hospitals and health centres, including the comrades who are on the different picket lines on the routes, who will decide whether to accept or reject it. If our rebellion was because a group of leaders decided on a miserable increase behind our backs, it will continue to be the rank and file who will decide the next steps. We call on the workers in each hospital and health centre to continue fighting for our decent pay and working conditions to continue in the front line of care for the population in this pandemic and the community to continue to support us.¨
Effects of the uprising so far…
The management tried to get oil workers to denounce health workers. Without success. The contractors complain about losses of millions. But the health workers’ struggle has also revealed that oil companies are raking in millions in profits every day. Another success of the ‘elephants’ (that’s what the health workers call their movement).
“We work in conditions of overwork and overtiredness. We’ve had to maintain daily operations, with a lack of materials and rudimentary equipment.” Since early March 2021, the staff of the Centenario Hospital in the Argentine city of Neuquén has been on strike against planned austerity measures. The women are at the forefront of this. They are fighting against deteriorating working conditions and trying to make up for the loss of childcare in the pandemic. The offer made by Governor Gutiérrez on April 14 to pay a bonus of 30,000 pesos (270 euros) was rejected by the workers and they continue to strike, with energetic support from the public…”
Video of one of the protest marches:
We were joined by a fellow health worker from Chicago who told us about the situation there and about their preparation for industrial action. She works in a public hospital, most of the patients are local working class people of Afro-American and Hispanic background. It’s the second largest hospital trust after New York. There are around 1,200 to 1,300 nurses in her hospital and in total 11 different unions for the various professional groups. The last time the nurses went on strike was in the 1990s.
The pandemic was a catalyst for the current surge of discontent amongst workers. The lack of PPE and the arbitrary decision of management to ration PPE pushed people to the edge. Our fellow worker from Chicago wrote an article about the collective actions (sit-down strikes amongst others) during that time for Labornotes:
Some of these actions also concerned patients’ safety, e.g. the demand for separate Covid wards. Due to Covid organisers of the union National Nurses United were not allowed inside the hospital, so most of these actions were organised by workers themselves. After a year of the pandemic the focus is now on payment of Covid bonus and better pay in general. The hospital management pocket the financial Covid aid from the government and don’t pass it on to staff. In Chicago, some of the money was bypassed to staff from the local prison.
In December 2020 the nurses organised a march on the boss, handing over a demand letter. Management reacted by threatening five nurses from the bargaining committee with the sack. After a widespread campaign that involved the community these threats were taken back. The current pay struggle happens on the background of lay offs in the US health sector, which makes things harder.
At the moment the nurses collect signatures for a strike pledge (a type of indicative ballot). They managed to get 50% of needed signatures within 72 hours, so the mood is there. In general unions abstain from going on strike in the public sector. National Nurses United will bargain for around 65,000 nurses nationally, the total number of nurses they represent is 177,000. Nurses push for a joint industrial action together with the support staff, something that has happened amongst teachers, but is rare in the health sector. Support staff organised a one-day strike in December in the Chicago hospital, which was met with severe threats from management.
We then talked about the current strike at St.Vincent hospital, a private clinic where nurses are on strike for six weeks now. The problem is that after two, three days the open-ended strikes tend to turn into lock-outs. In the St.Vincent case management recruits replacement nurses and pays 30,000 USD a day to the local police to keep the entrance to the hospital free. Replacement nurses are hired by special agencies from around the country. They normally have top be trained locally, there is a chance to refuse training them.
At the Chicago public hospital the union talks about one-day strikes, while many workers say that they should walk out until demands are met. In some cases striking nurses set up ‘rapid response teams’ in case something goes severely wrong with patients during their strike. The doctors are generally sympathetic, but tend to chose a path of least resistance. Some doctors and medical students became more radical during the BLM movement.
The nurses haven’t been able to organise any physical meetings yet, due to Covid, but had physical protest actions with social distancing. The Zoom meetings work well, though, with more people attending than usual, up to 200 workers. The industrial action is likely to happen late May, early June – we will try to have another meeting to discuss the developments and share the experience with health workers here in the UK.
This short report from fellow workers of our network raises important issues for our current struggle for higher wages. The action of the nurses show that management reacts to collective pressure from below, even if only a small group of workers are involved. While it is important to have a broad struggle for higher wages, this struggle might not come about through one central mobilisation, but might well be the result of workers taking action on a department or hospital level, which then inspires others to do the same. The short report also shows that we have to overcome a few barriers to broaden the struggle. We see the division between the local ICU nurses and the agency staff – the ICU nurses want to prove that they are more ‘cost effective’, while some of the agency nurses might not have been interested in the general work atmosphere, as they ‘stay only for a few shifts’. We need to address and overcome these divisions…
In this particular ITU some of the staff recognised that the use of agency nurses was increasing. There are two types of casual workers within this trust ‘agency’ and ‘bank’. Agency nurses are higher paid than bank staff, particularly if they are intensive care trained and as bank shifts on intensive care cannot be filled by regular ward nurses, it needs to be ITU staff, the pool of people to fill spaces in the rota is more limited. Agency workers are not staff belonging to the trust that they pick up shifts in, they are sometimes purely casual workers belonging to specific agencies, or they may be permanent workers in another nearby trust. Bank workers are employed by the trust and are often permanent workers already looking to pick up extra shifts. In this particular case, there had also been some concerns that paperwork wasn’t always being completed by the agency staff and therefore permanent staff were also having to pick up more work as a consequence.
A nurse put together some well thought out costings that proved if the trust were to increase the rate of pay for bank shifts for their permanent staff then the uptake of these shifts would be greater and the need for agency staff would be less. With an overall cost reduction. This was agreed on by management and indeed staff began to pick up more bank shifts.
This went on for a few months, however, management decided they would no longer be willing to stick to this pay increase and the bank incentives were removed. As a result, the decision was made by ITU staff to cancel their bank shifts on ITU as a protest to the removal of the incentives. The result of the permanent staff cancelling their bank shifts was that there were more agency nurses needed and also gaps in the rota. This act of protest by the team has led to management increasing the pay for bank ITU staff permanently. There are around 250 permanent nurses in intensive care, with about half of those regularly picking up bank work (one shift a month or more).
Strikes in Germany
We were joined by two fellow workers from Germany, one working at a private hospital with 1,200 workers, they other in a public sector clinic with over 10,000 workers. They talked about the European-wide 1988 hospital workers movement, which remained largely independent from the official organisations. In Freiburg workers went from care home to hospital to community care centres and mobilised up to 200 workers for weekly meetings and protests. These were seen as ‘hospital workers’ meetings, unlike today, where people speak about ‘nurses mobilisations’ – which reflects the deepening ‘professional’ divisions within hospitals.
They talked about the fundamental shift in the health sector in 2004, when a health ‘reform’ was introduced which opened the door to further privatisation. The government also introduced a ‘flat rate per case’-system, which means that hospitals had a financial interest to increase the patient turn-over. Since then the nurse – patient ratio has increased to 1 : 13, at the private clinic even 1 : 35 at times.
The workers’ group at the private clinic started with newsletters and leaflets, independent from the trade union. In 2016 they were able to hold public meetings with more than 100 workers. At the time the union ver.di mobilised for a strike action for ‘minimum staffing levels’ – these strikes were first envisaged nationally, but then focussed on 13 individual hospitals – out of a total of 2,000 hospitals. These were 1 or 2-say strikes, where the union had agreed to a ‘minimum staffing level’ which was actually not much below the staffing level on a normal working day. At the clinic where the fellow worker is employed management agreed to join the public sector contract, which didn’t bring much improvement to workers, which led to disillusion. many workers left the hospital after the strike. The strike were successful in the sense that they hit hospitals in the pocket (postponed surgeries etc.), but had very strict rules, didn’t overcome the existing divisions between nurses and other groups, core and outsourced staff etc. and didn’t leave much scope for independent initiatives from workers. Overcoming these divisions seems the biggest challenge for future strikes. During the Corona crisis there have been actions at the private clinic against lack of PPE (Banner drops, public protests), but no strikes.
We have translated two longer texts on the situation in Germany and will re-invite the two friends to discuss them in more detail.
Updates from the UK
The RCN has announced workshops in order to train people how to mobilise for strike. They will start around 18th of May – it will be interesting to see if these are just top down ‘organising tools’ or more interactive and connecting people on the ground. We briefly discussed the inner contradiction within the RCN of being a professional (career) development organisation and a union. Many people seem to leave for unions like Unison or the GMB – which indicates that the current pay campaign might also exacerbate the union competition.
Workers in some trusts (Bristol, …) have received little perks from management recently (extra holiday, ‘seeds’), which shows that they feel they have to relate to the murmurs somehow. Unison send out mails to ‘be ready for ballot’, but that only meant to check if the union has your right address. Not much else happening on trust level. In Bristol there were no actions of the NHS15 campaign on the 1st of April.
In Birmingham the porters protest against new rotas (as a result of a trust merger) seems muted. Porters of the merging trusts don’t seem to know much of their respective conditions and there is not much talk about the dispute even within the union involved, Unison.
Future plans and announcements
We want to discuss a short platform for the network, talking about our perspective and aims. We also want to discuss what kind of material we can produce in order to contribute to the wider discussion around the pay campaign. People are encouraged to work on drafts together.
The next regular meeting will be on the 6th of May, 7pm.
If people want to join US health workers in a discussion about the current situation there is a Labornotes webinar on the 18th of April. You can register here, the session will also be recorded:
After the insulting 1% pay offer, NHS workers have started talking about going on ‘strike’. We have seen a few strikes by hospital cleaners, porters and junior doctors over the last few years, but there haven’t been many industrial disputes that involved all hospital workers together.
A strike in a hospital is different from stopping work in a factory or office – we deal with patients, not tax returns or rubber ducks. At the same time, we can only enforce our demands if the hospital management and government feel the pain of us not working for them. They’ll only budge if the hospital bosses feel the financial pain of cancelled treatments or money spent on replacement health workers (scabs!) They’ll only budge if the government has to deal with an irate public in desperate need for health services.
We know how to keep hospitals running, despite austerity measures, under-staffing and lack of resources. This means we can also make sure patients are kept safe at the same time as refusing to do other work which is not absolutely essential. The main thing is that we find forms to organise where everyone involved in the work is also equally involved in the running of the strike – from cleaners to porters to nurses to doctors. We have to organise beyond the boundaries of professions, unions and single hospitals if we’re going to win our demands.
Here in the UK, we haven’t got much experience with industrial disputes in the health sector, but we can learn from the past and from health workers abroad. Over the last couple of months, we’ve collected at least a dozen news reports about healthcare workers’ strikes all over the world – and these are only reports that available in English, French and Spanish. You can imagine how many more disputes are going on that we don’t hear about!
In Massachusetts in the USA, around 700 nurses at St. Vincent hospital have been on strike for more than five weeks. Management made an agreement with support workers, which split the strike. They pay up to $110 per hour for scab nurses. In the meantime, health workers in Chicago and 4,000 hospital workers of Allina health corporation also threatened to walk out.
As well as the USA, we’ve seen strikes in France, Greece, Sudan, Uganda, France, Greece, Sudan, Uganda, New Zealand, Australia, South Africa, Myanmar, Ghana, Pakistan, Spain, Nigeria, Cyprus, Hawaii, India, Germany, Paraguay, Honduras, Kenya, Haiti, Peru, Argentina, Algeria and Mexico. These struggles are over things like: outsourcing, non-payment of wages, victimisation, unpaid bonuses, general civil disobedience, lack of PPE and other resources, contract disputes and pay. Follow us on twitter to get links to more in-depth reports about these struggles