A Strike to Keep Us Working

Strikes have spread to more than 200 emergency rooms across France, as nurses and health-care assistants call out the neglect of public hospitals. The striking workers don’t want to disrupt vital services — they’re acting to stop Emmanuel Macron from running them into the ground.

A hospital workers' strike on April 11, 2018 in France. Force Ouvrière / Flickr

Laurent Gleizes, forty-seven, has been working in Nice’s public hospital system since 1994. But this nurse — a union representative for the General Confederation of Labour (CGT) — says conditions have never been so dire, characterized by pay freezes, overcrowding, and patients’ boiling resentment against staff. That’s why he went on strike last Wednesday, joining dozens of his colleagues across emergency rooms at the city’s four public hospitals — and thousands more workers nationwide.

“We’re calling out management and the government over the lack of both human and material support that are necessary to fulfill our mission of public service,” he told Jacobin at the CGT’s union office in Nice’s Cimiez Hospital. “Working conditions have been declining systematically.”

Many nurses seem to agree — and not just in Nice, where roughly a third of the city’s two hundred public hospital emergency room staffers have gone on strike since Wednesday, according to the CGT. Strikes are also affecting a whopping 203 emergency rooms nationwide, according to a count from a national workers’ coordinating committee in late July. That’s a sizable share of the 478 public emergency health services across France.

“We’ve arrived at a general sense that enough is enough,” says Stéphane Gauberti, forty-eight, the head of the CGT at Nice’s four public hospitals.

But if workers are unhappy, the nature of this workplace makes it a rather atypical strike movement. Indeed, so-called minimum service laws legally bar strikes from shutting down emergency rooms. As a result, many of those officially declaring themselves “on strike” are in fact withholding their labor for short intervals, all the while ensuring that care isn’t interrupted. Others have taken medical leave in protest, while still other sympathizers have stayed on the job while showing their solidarity in different ways: attending rallies, wearing armbands, and signing petitions.

In any case, the emergency room strike wave has only grown since kicking off in March, becoming an inescapable source of headaches for Emmanuel Macron’s government. The workers’ actions may not have generated as much media attention as the Yellow Vests. But much like the gilets jaunes, nurses, health aides, and other emergency room staff are drawing attention to one of France’s defining political issues: the defense of public services at a time when they’re under attack like never before.

Services Under Pressure

While France’s health-care system remains a world leader, there is a widespread sense that the quality of care has declined in recent years. In 2000, the World Health Organization ranked France’s system as the world’s best, but more recent studies have placed France further down the league tables. A 2018 study from the Lancet measuring health-care “access and quality” ranked France in twentieth place, ahead of the United States and the United Kingdom, but behind Canada and neighbors like Italy and Spain. The most recent annual Euro Health Consumer Index report, meanwhile, put France eleventh out of thirty-five in Europe — a study that accounts for patient rights, waiting time, services, and prevention.

Strikers pin the decline in quality on a very simple reason: a lack of funding. Hospitals are largely financed by payroll taxes — that is, contributions from employers and employees that finance the national health-insurance system. Since 2010, the government has aimed to control costs by fixing the annual health-insurance-spending growth target at under 3 percent. At the same time, actual health-care spending is growing at a faster rate — around 4 percent per year — reflecting an aging population and the fact that more people are seeking care today. Between 1996 and 2015, the number of annual emergency room patients nearly doubled.

Instead of boosting spending, the government has tightened the screws — forcing hospitals to make do with fewer resources and fewer workers to bear the brunt. Along with the rest of the civil service, public hospital employees haven’t seen a raise since a modest pay bump in February 2017. Base pay had been frozen for six years before that. At the same time, hospital employees have seen the introduction of new management techniques to manage the crunch. Workers now have individualized plans with specific targets and are expected to master several different specialties over the course of their career — to become, in French management-speak, polyvalent.

The tension is all very palpable on the shop floor, says Gauberti, the CGT leader who started as a health assistant in Nice in 1993. “Today, we’re focused on budgets and accounting, while back then, we were still grounded in a vision of public health. When we had patients to bring in or work to do, we weren’t asking ourselves the question, ‘How much is it going to cost?’”

Public Support for Public Services

The movement began at a Paris hospital back in March, triggered by a string of physical assaults against staff. From January to March, emergency room employees at Paris’s Saint-Antoine Hospital counted eight separate incidents, against the backdrop of long waiting times and a lack of beds for patients. The strike quickly spread to other emergency rooms, with activist workers launching a collective to improve coordination: Inter-Urgences. Critically, this took place outside formal union structures. While employees do rely on unions to make official strike declarations — providing legal backing for absences from work — they’ve coordinated demands and various actions through the collective. Their central demands today include a €300 monthly pay raise, ten thousand new hires in emergency rooms, and an end to the practice of admitting patients on stretchers — a desperate measure undertaken when there are no beds available.

“We didn’t want unions to negotiate in our place,” one Paris hospital employee told the AFP news agency in June. “We saw quickly there could be little squabbles between them.”

In some cases, hospital unions are seen as stodgy and not responsive enough to shop-floor demands. In others — like in Nice — unions did organize the strike. Regardless, the movement has tapped into a sense of frustration. By April, around twenty-five hospitals were on strike, most of them in Paris. By early June, that number had reached eighty nationwide. On June 6, the Inter-Urgences collective organized a march in front of the Health Ministry in Paris, drawing two hundred protesters, according to Le Monde.

That demonstration finally led to concessions from the government. Last month, health minister Agnès Buzyn announced a €100 monthly bonus for emergency room workers and promised funding aimed at making more hires. But this has done little to slow the movement. Strikes didn’t just continue — they expanded to reach more than 130 services by the end of June. Many are demanding the full €300, in the form of a full-fledged pay raise — thereby ensuring that it comes with the social contributions that help fund the health-care system.

The workers taking action also enjoy overwhelming public sympathy—in large part because much of the French population is familiar with the very problems that employees are denouncing. An Odoxa poll in late June found that nine in ten French people backed the strike. That’s even bigger support than the Yellow Vests could point to at the peak of their movement late last year, or indeed striking rail workers in the spring of 2017.

The public approval doesn’t come as a surprise to Gleizes. “It’s linked to the health system in this country,” the nurse says. For him, it’s about an “ideological battle to maintain a system funded by social contributions, and not just a system of big private insurance that penalizes the most precarious people.”

As the movement rolls on, a key question is whether the government will make further concessions. No matter the final outcome, though, it’s a reminder that collective action still gets the goods in France — even under Emmanuel Macron. And as unions gear up for a tough battle over the proposed hike in the retirement age this fall, they could use just about as much encouragement as they can get.