Friends from France have written a detailed paper on the question – read it <a href="https://mouvement-communiste.com/documents/MC/Booklets/BR6_Sant%C3%A9%20_EN_vF%20Site.pdf">here</a>.
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Debate on the current character of hospitals and their restructuring

There are good reasons why we need more workers’ and patients’ control over the health system. The pandemic was a prime example. We were able to see how disorganised the system is and how different players just followed their own interests. The national governments are pretty detached from the wider world of hospitals and labs. These same national governments are often in competition with each other, which is fatal if you have to react to global problems such as pandemics or climate change. The big private corporations that produce vaccines or PPE are also scattered, each just following their own goals. There were good people in medical science who had a critical view on the government plans, but they were powerless when it came to practical application and separate from the daily experiences on the wards. Hospitals didn’t coordinate effectively with the community and care homes, which was fatal in hundreds of cases. As part of the working class we, as health workers, were not united and conscious enough to provide society with an alternative pandemic plan. This will be our responsibility in the future.  
We need more effective control. But this is easier said than done, because we are boxed into our separate professional groups and departments. Medical knowledge is not just unevenly distributed – it is often monopolised by elitist science and corporate patents. The health sector mirrors the problems of society at large. Some workers are caged into complex and specialist knowledge and run the risk of becoming blind to the wider context of their work, let’s say brain surgeons. The large majority of workers are caged into repetitive jobs where you hardly learn anything new. The potential creativity and productivity of billions of people is completely wasted for society!
We are not brain surgeons; we are modestly skilled hospital workers, but with this series we’ll try to understand the development of two main sectors better. We work in local Bristol hospitals, but at the same time our work is closely intertwined with the global pharmaceutical industry and the device and implant industry. These industries connect the local, supposedly ‘public’ hospitals to the circuits of global development and money streams. For example, nearly one sixth of all annual hospital expenses, from wages to buildings, go straight to the pharmaceutical industry. In the case of one of the local hospitals that’s £150 million a year. Some of the private companies hire operation theatres and NHS staff for elective surgeries on weekends – at the Bristol Eye Hospital porters can make three times as much money on a ‘private’ shift compared to a regular shift. Some of the training for scrub nurses is provided by reps of global instrument manufacturers. Most NHS IT systems are run by global corporations, such as ATOS. The connections are endless.
There is a lot of journalistic material about these multi-billion industries, but journalism itself is a private industry and relies on ‘scandals’. And it is easy to find scandals in these industries, from hip implants that give people psychotic episodes due to cobalt poisoning, to the suffering of thousands of women who were given vaginal mesh implants or fallopian tube coils that had never been properly tested. It is important to hold the big corporations to account, but we also have to understand them from within, by reaching out to lab workers, surgeons, and science workers who have more insights than the journalist who looks for a good story. Yes, global medical corporations follow their own profit interest, but within these companies workers generate actual new knowledge. Most of them will get frustrated by the way that market goals limit the development of better medical technology. In academia as well, competition amongst medical researchers (which individual or which institution publishes more papers, gets more funding, etc.) prevents supportive cooperation and the development of a global human knowledge. We have to work together to break this human potential out of the tight shell of the corporate or academic boundaries. We need a counter-science where critical scientists, doctors, nurses, patients analyse new treatments together. We can see this slowly developing in other sectors, too, for example when tech workers at Google or Amazon start criticising the military or state surveillance use of their products or the impact on the climate. In some cases they link up with lesser skilled workers in the warehouses, which could give their critique a more powerful base.
Our class, the working class, has produced an enormous wealth of medical knowledge and resources within the boundaries of the market and particularly during times of social change the working class movement has also managed to popularise more of that knowledge. In India in the 1970s and 1980s doctors left the elite hospitals in the major cities and travelled amongst the rural villages, helping to build peoples’ hospitals. In Italy in the 1970s a movement and psychiatrists and mental health patients questioned the repressive asylums and developed alternative ways to deal with psychological problems. In the 1970s midwives and mothers started to develop a new knowledge on birthing that was focused on the mother and the baby, not the medical vanity of the doctor. In Germany a movement of<a href="http://vdää* - Verein demokratischer Arzt*innen (vdaeae.de)"> critical doctors</a> and health workers organised inquiries amongst chemical and other industrial workers, about hazardous substances and unhealthy working conditions &#8211; and they are still going strong.  We can stand on the shoulders of previous generations of our class. 
In the upcoming issues we will make first baby steps towards an understanding of these two main industries – the pharma industry and the medical devices and implants industry within surgery. Our focus will be on questions such as: How is knowledge and technology developed? What are factors that facilitate and what are factors that hinder this development? What role does the market, competition, tight budgets, corporate goals play in all this? How does the hierarchical division of labour impact on knowledge development? How can alternative forms of equal cooperation emerge? We would like to speak to surgeons, lab technicians, pharmacists about their views and experiences. Feel free to get in touch!

Issue no.1 – For workers’ and patients’ control of the health industry

It feels like every conversation that we have with co-workers these days is the same. We&#8217;re all stressed out, the good shifts are the ones that don&#8217;t leave us feeling like a zombie when we&#8217;re done. There&#8217;s never enough of us and there&#8217;s too many people that need us. It’s not just us workers who are beaten down, but the patients as well. We call our work care work, but how can we care for people when it feels like a factory that just needs to get people out the door as quickly as possible? We’re all aware of the problems, we’re the ones who deal with it day in and day out. Right now, a lot of the frustration with the way things are both at work and beyond is limited to individual moaning and bitchiness. It&#8217;s more likely to hear people blaming a “lazy” co-worker for their problems than the hospital managers, national NHS leaders, politicians.
Even just across the NHS, there are 1.4 million of us working every day and night to make sure that society keeps running. We work in complicated connected ways, all of us relying on hundreds of others to provide care for the sick and innovate new ways to improve lives. We are like the backup motor of society, always running and always ready to take over when things go wrong. Because of this, we have a potential power as workers in an essential industry.
For business as usual to carry on, the people in charge not only rely on the work that we do, but they rely on us doing it passively, never asking the question of whether things could be done differently. Individually, we stay weak and divided, but collectively we have a unique position: our work and collaboration ranges from hospital wards to medical labs, from operating theatres to medical science departments, from community surgeries to manufacturing sites for devices and implants. As united health workers we know about both social needs and technological developments and from this basis we can contribute to an alternative vision of a new human society: where we use knowledge and technology consciously for a better life for all, not for profits and wars.
Vital Signs is an attempt by a group of workers across the two main hospitals in Bristol to give space to this perspective – you know the hospitals, one where the lifts never come and the other hospital dressed up as an airport with a £250,000 clock that nobody knows how to read. This magazine represents an effort to create a forum where together with co-workers we can reflect on our experiences, our struggles and our potential to create solidarity across bands, departments and professions. In this first issue we’ll introduce some of the key themes we want to explore.
In &#8220;<a href="https://www.vitalsignsmag.org/posts/issue-no-1-short-staffed-and-short-changed">Short Staffed, Short Changed</a>&#8221; we’ve done interviews with co-workers in different jobs on the issue of short staffing, how it affects these workers and the general operation of the hospital. “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-for-workers-and-patients-control-of-the-health-industry">For workers’ and patients’ control of the health industry</a>” looks at the way that medical and scientific knowledge is structured in the health industry. Normally this knowledge is kept separate from workers and patients, and we want to question that. We did an interview in “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-bye-bye-dubai-hello-bedminster">Bye Bye Dubai &#8211; Hello Bedminster!</a>” with a colleague involved in training nurses from abroad, which explores the messy exploitative way that the NHS pulls people in with grand promises and the reality when they get here. “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-re-banding-or-banding-together">Re-Banding or Banding Together</a>” is a conversation between two Health Care Assistants (HCAs) at different trusts about the campaigns to put HCAs up to Band 3. In “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-against-the-global-trauma-ward-against-the-bosses-wars">Against the Global Trauma Ward</a>” we look at how the wars going on around the world affect us and our struggles “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-the-letting-game-letting-you-down">The Letting Game &#8211; Letting You Down</a>” touches on the difficulties of renting in Bristol, and “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-tears-sweat-and-placements">Tears, sweat and placements</a>” invites students working in the hospitals to engage with Vital Signs and reflect on their experience. We look at the local strikes since the big pay dispute a couple of years ago in “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-minimum-wages-for-maximum-stress">Minimum Wages for Maximum Stress</a>”, attempting to draw out some of the lessons we can learn from our colleagues on taking action. In the final article, “<a href="https://www.vitalsignsmag.org/posts/issue-no-1-hca-philosophy-for-a-new-relation-with-patients">HCA Philosophy</a>” reflects on our relationship as workers to patients, and how sometimes the “professional” conduct we are encouraged into stops us from developing real human relationships across that divide.
The following is an introduction to the project, its aims and its politics.
Healthcare work after COVID
Since 2019, the position of health workers in society has had a lot more focus on it. On the one hand, the Covid pandemic revealed the importance of our work particularly at a time of social crisis. We were celebrated as ‘key’ and ‘essential’ workers. We were called ‘heroes’. In this time, we took on a role of responsibility for society in general. On the other hand, only a year after the Covid crisis began to come under control, we began to push back across the NHS. When we turned around and demanded a pay increase, even just to claw back some of the pay that we have had cut over the last 15 years, the government and the bosses said that we were irresponsible or greedy. Because we weren’t united at the time, we weren’t in a position to struggle effectively. Different unions went after different pay offers, certain groups of workers went on strike at different times, and key issues like staffing levels and work stress were avoided by the official unions. Because there was a lack of worker and patient control over the hospitals and the wider NHS, the bosses and politicians were able to use the dividing lines that exist to stop our strikes from being effective. Now, only the junior doctors are still going on national strikes and the rest of us have gone back to work with nothing really having changed. We were sold bad pay deals below the level of inflation by the union head offices and hospital management. The questions that we want to ask are ‘what would it take to win?’, and more importantly ‘what are we fighting for?’
The pandemic showed how much we need workers’ control of the industries that we work in. The response from governments and corporations was chaotic and contradictory with each pulling in different directions. In a lot of cases, workers had to enforce their own health and safety procedures on the bosses, because there was no plan in place and when they tried to implement things they didn’t understand the conditions of work. While massive parts of the workforce were either unable to work or working from home, workers in central industries were pushed to work for longer to make sure things kept running.
We saw it in healthcare as well. There is a separation of the governments and the medical experts that they drafted in, and a further separation between those medical experts, the various self-interested medical corporations and the actual conditions on wards and in A&amp;E. Sense went out of the window over and over again. We deal with infectious diseases all the time and know what to do to prevent them, but if we went to the park on a weekend to meet up with a friend or to take the kids out of our garden-less flat, we’d be threatened with fines. Justified scepticism of the government was allowed to develop into conspiracy and anti-social ideologies. If we as health workers had been more united, we could have provided a basis for the rest of the working class to develop not only an understanding of the science and health concerns, but its own plan for dealing with the crisis – one that didn’t let thousands die in care homes, or in cold-storage warehouses. These crises will only become more frequent and more dangerous. Whether it is pandemics, economic, or climate based crises, we need to develop the unity and consciousness to design our own plans for society that don’t put our lives in the hands of abstract forces like the market and fiscal rules or detached politicians.
Strikes and self-defence
The strikes that happened over the last couple of years could have been an opportunity to begin building this unity and consciousness. For the first time in decades you had workers across job roles, professions and unions all taking an active stance to defend our pay and conditions. Instead, we allowed the government and the bosses to lean into the divisions that already exist. They played workers in England off against workers in Scotland and Wales by offering separate deals which meant that they were not part of the strike movement anymore. They tried to set junior doctors against nurses, nurses against HCAs and domestic etc. We didn’t have the connections to put up a fight against this. The unions let it happen. Even when each one was launching a pay claim, they all went for different demands! They didn’t even really want to work together. The bosses were able to use this against us and we ended up getting offered a bunch of crap deals. Inflation was at 14% for ages and we got offered 2%. We’re worse off now than we were even a couple of years ago. At the same time, the union headquarters wanted us to accept the crap deals. The online initiative NHS Say No organised by members of different unions was an impressive attempt to push back against the union bosses, but it wasn’t able to establish itself as a presence in many places. Because of this, issues of work stress and understaffing were only really raised as secondary issues in the big dispute, even when this is really what’s at the top of our agenda. Why are we having to work 12 hour shifts to make ends meet?
We want this magazine to provide a bridge between workers with different skill sets, on the basis that we are all workers no matter what little cage the bosses try to put us in. Vital Signs is made up of workers from the lower rungs of the hospital hierarchy ladder, but we want to engage with workers from as many different sections of the hospital as possible. If we are going to prepare for the next wave of struggle, and prepare to win, we need to learn lessons wherever we can. We will look at history and at struggles of hospital workers in other countries like Germany, the US and Argentina to see what has been successful. We will try to make sense of different aspects of the medical science industry to gain a better understanding of the work that we do and how it relates to the wider system we live in. We want to investigate the health of working class people and give space for new relations between workers and patients, not always so sanitised in professionalism.
Workers’ Control and Transition
Vital Signs is an attempt by a group of workers across the two main hospitals in Bristol to challenge and overcome the problems that we face in our struggles. On top of this, we want the magazine to be a space where co-workers can begin to think seriously about the industry that we are in and what it would take to transform it, and run it. The political parties like Labour can’t be trusted, and the unions have their own interests. Any attempt to build working class power has to start from us, the workers ourselves. We have to develop our own organisations and institutions that we can use to direct our own struggles.
As we have seen, in moments of crisis, governments rely on workers in industries such as ours &#8211; those that are essential to society functioning &#8211; to keep things running. In these moments of crisis, we have to be in a position to put forward an alternative vision and lead the struggle to achieve it. Collectively, we have extensive knowledge about running a huge cooperative project, we produce new knowledge and develop ways of doing things every day but as it exists the NHS is separated into hundreds of divided groups and these divisions limit our power.
We are 1.4 million workers in the same industry, but how many of us know or understand the work of our co-workers? Does the nurse understand the problems that porters have to deal with at work? What do housekeepers know about what pharmacy assistants have to deal with and vice versa? This magazine will make attempts to break down these divisions, and allow us to look critically at the NHS and the wider system of global development that it is embedded in.
If you’re interested in what you’ve read then get in touch!
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Debate on the current character of hospitals and their restructuring

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Issue no.1 – For workers’ and patients’ control of the health industry

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