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.
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.
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.
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.
