Wed Jun 19, 2024
June 19, 2024

The struggle for health in France

Interview by Martin Ralph – International Socialist League
A French health worker answers questions about their struggle and in doing so shows the European struggle for public health is a central question for all countries in Europe, against health cuts, privatisation, and capitalism.
We also take the opportunity to express our solidarity with the health workers’ struggle and our agreement that as workers we need to exchange experiences and build common links of the struggle between France, Britain, and all European countries.
Can you tell us what your profession in the health sector is and what your union is?
I’ve been a nurse at the Brest hospital for 18 years and I’ve been a CGT [a large union central with many militant members] member since 2004 (with a break between 2010 and 2016 – during the strikes against the reform of pensions in 2010 I didn’t feel supported by my union, either locally or nationally). At the time, I wasn’t covered legally by a renewable (an indefinite or regularly occurring) strike notice. It took the movement against the 2016 Labour law for me to find the desire to participate, once again, in the militant life of my union (while bridges and junctions with other collectives in struggle were then being created locally).
1) We saw that in July 2020 (and even before that) French public health workers fought for better wages, better working conditions, and the hiring of more staff, with mass demonstrations and strikes – demands largely similar to those made in Belgium and Britain. Can you explain the reason for these different demands?
As I said, I joined a trade union in 2004, 2 years after I graduated. At the time, a re-organisation was being set up at the hospital (new structures and an internal market, etc.) and people were already denouncing the “business-oriented hospital” and its management method, which is a sad reality today. 
The deterioration in working conditions and the closing of beds has only got worse since then. Indeed, counter-reforms in health care have followed one another: rationalisation of care according to targets and not need, lean management – continual changes that “optimises” resources for the customer i.e. the patient, and which seeks to get more from fewer health workers, management, the concentration of “skills” within large hospital complexes, competition with the private sector which has no public service obligation (and favours the most remunerative interventions), the omnipotence of supra-institutional bodies (Regional Health Agencies), full powers to hospital management which no longer take account of the so-called “social” dialogue. 
These are the conditions for a major deterioration in the supply of care which, in my opinion, created the 2019 crises in emergency services and the tricks of the government’s trompe-l’oeil responses. Let’s add to that the freezing of our salaries for almost ten years. 
The current crisis has only repeated the process, nothing has really changed since 2019. In June/July 2020, the Ségur healthcare forum was held, a sort of major consultation (again) to make “new” proposals to “improve” health in France. My union refused to take part, already foreseeing that once again the government would only partly respond to the legitimate demands of the staff and the population. The conclusion is clear, the bed closures continue, we asked for a wage increase of 300 euros and we got 180. Nothing about democracy in the hospital: the director remains the only master on the board.
2) Can you tell us which unions were involved in these actions? And did these actions obtain the support of other workers and of the French people?
Something new happened in 2019, collectives have been invited into the battle (inter-emergency collective, inter-hospital collective with strong involvement of some doctors). The alliance with the other combative unions (such as other sections of CGT, and also SUD) didn’t always go well but it allowed the emergence, in my opinion, of the health question and the political choices at the centre of the debate during 2019. However, in spite of a mobilisation that the healthcare sector had not seen for a very long time, the hospital has not gained anything. 
COVID and the issue of ICU beds have once again highlighted the negligence of our healthcare system, and perhaps that is the gain in 2019 – the awareness of the population that our hospital is sick and that something must be done. In Brest, in June 2020, there were 5000 of us (never seen before regarding healthcare issues) in the streets at the end of confinement that lasted several weeks.
3) Was it possible to obtain a unitary action with these unions?
Yes, as well as with the collectives and the Yellow Vests [a very militant community movement against many social problems in France]. 
However, it should be noted that another union (the CFDT) only participated with us fleetingly. They were still in the majority in my hospital not long ago. This trade union division, in terms of objectives and strategy, harms us (both carers and cared for) and plays into the hands of the government, which can claim an agreement with a large representative organisation (that’s what it obtained from the CFDT, especially this summer), who did not have the same struggle objectives.
4) What did the government propose? Did the health workers get satisfaction from Macron?
The two main measures are an increase in the remuneration of professionals to the tune of 8.2 billion euros annually (7.6bn for non-medical professions, 450mn for doctors and 200mn for students) and an investment plan of 19bn euros.
Concerning the increase in remuneration, it is 180 euros net: not negligible but far from our demand of 300 euros (which had the objective to raise French salaries to the average of OECD countries). And here again, it should be noted that many staff are excluded, as several health and social structures are excluded, such as the CSAPA (health, support, and prevention centres specialising in addiction) or SESSAD (special education and home-care based services).
As regards the 19bn investment plan, when you look more closely, this will amount to 500mn per year for the whole of France (in Brest, not the biggest hospital complex in my country, the annual budget is around 350mn euros!!).
5) How has the Covid crisis impacted the fight for these demands?
The restrictions of liberties, the fear to come in demonstrations (fear of the virus but of course also fear of police violence) effectively impacted the struggle. Nevertheless, in view of the demonstration in June, I think that it would be possible to mobilise massively again in the future. When? How? I don’t know. 
6) Demonstrations took place in October, according to the reports, to put an end to the closures of hospital services, the atrocious working conditions, and the shortage of staff. Was this struggle well supported? What was Macron’s response?
Not here in Brest, at the moment (but that can change very quickly!) the battle is once again taking place between the carers. The workload of the current crisis, the hard blows from our management monopolise a large part of the trade union activity and I expect nothing from Macron.
7) What do you think of the way Macron handled the Covid crisis? And is this vision widely shared?
They managed it catastrophically: masks, beds… all lacking nothing changes here. 
But for a more in-depth analysis of the management of this pandemic I can only refer you to the excellent text by Nicolas da Silva published on the Contretemps website. 
8) In 2021, what do you think might happen in support of the demands?
Again, I don’t know but I remain optimistic and I can see an increase in social movements and their amplification since 2016.
This year we are celebrating the 150 years of the Commune: who knows?
9) The struggles of health workers for a satisfactorily funded and publicly planned health service are developing in France, Belgium, and the UK, with different tempos and experiences. Do you think it is possible to start linking workers and activists on a European basis to build common struggles against government and employer interests?
I think it is essential to know what is happening beyond our borders and to be able to build links between internationalist activists. I must confess my almost complete ignorance of your health care system and the struggles you are waging at home. I am interested in any information on it.
Thank you for your interest and I wish you, for this new year, great victories over this capitalist world.
See you soon!

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