We document two recent struggles of health workers in Toulouse, France. The first short report concerns a current strike of medical secretaries for higher wages. The second text deals with the struggle to defend a local mental health hospital against restructuring. Their struggles are similar to ours in the UK and so is the wider social context. From Tories to Labour, from Sunak to Macron – all talk about more money for the military, while cutting money for health and social services.

Strike of medical secretaries at Joseph Ducuing hospital for higher wages

26th of June – 6th day of strike

The workers demand a re-grading of their wage band, given the real wage losses they have suffered over the last years. The base rate of their wage is actually below the minimum wage and the enhancements for seniority and having a diploma hardly compensate for the low pay. “The enhancements are also not included in your pension, they are not actually a real wage!” explains one of the striking secretaries. Around 30 of them gather at the picket-line in front of the hospital, with 80% of all medical secretaries participating in the strike action. They are also angry about the fact that other health workers have recently received pay increases. The hospital management justifies this with having difficulties to recruit people for certain jobs and that therefore they have to offer higher wages. The secretaries make jokes about the fact that there are also several vacancies for medical secretaries that cannot be filled. 

“When you are new in the job, it is hard. We had cases where new people start the job in the morning, don’t return from their lunch break and are never seen again. They find money to increase the pay for surgeons, but not for the surgical secretary. We have an important role in the functioning of the hospital.” 

The hospital management claims that they cannot pay higher wages given that the hospital runs a 4 million Euro deficit. 

“As if it was us who ruined the hospital.” 

The striking workers hand out leaflets and organise a buffet in order to create connections with the hospital patients. They also address other hospital colleagues.       

 

The struggle to defend Esquirol Hospital, spring 2024

Psychiatry: What is the political situation in the sector and why has it come to this?

The collective for the future of the hospitals Saint-Maurice et Les Murets (and in defense of Esquirol Hospital) was formed in May 2023 and fights against the construction project that is pursued by management and the regional health agency (ARS). This project is part of a health policy that is aimed at reducing investments in public hospitals. The plan is to sell more than half the hospital’s buildings to property developers, in order to build new buildings that are three times smaller on a listed forest area in the hospital park. This struggle for a dignified psychiatric service takes us to a point where territorial, ecological and social politics intersect. This struggle concerns the lack of social housing in certain areas, the bogus commitments to preserve biodiversity and the so-called ‘non-artificialisation of land’, as well as the provision of local and long-term care. As far as public hospitals are concerned, the government has been shouting for years that there are too many hospital beds in France. Using the pretext that patients need to be ‘empowered to be independent’ they propose to transfer more and more care outside the hospital: the famous ‘ambulatory turn’. But the deterioration of hospitals is such that nowadays departments are also closing because of a lack of staff.

Since the 60s, psychiatry has been offering local care, before or after a treatment in hospital, thanks to the sector policy. This is a territorial service designed to provide care close to where people live and come into contact with healthcare services. In each area, medical-psychological hospitals, day-care and crisis centres, or even part-time therapeutic surgeries work together to create a network of care in the city throughout the care pathway. Currently the government continues to close inpatient wards without providing any resources for outpatient care. In reality, this policy of proximity, which is particularly suited to the most vulnerable and to long-term care, is also being undermined by another government policy, i.e. the idea of dividing up care according to pathologies. With this policy, private clinics and ‘expert centres’ are springing up everywhere, focusing on diagnosis and medication rather than on therapeutic and social relations. Under the guise of early detection, the aim is to refer patients to the private sector through public funding of private sessions. In addition to this, since 1 January 2024, psychiatric funding has been based on a ‘T2C’ system which is an attempt to develop an individual activity-based pricing system for psychiatry. Until now the psychiatric services had been financed with a global budget based on the sector’s population, due to the fact that psychiatric activity is difficult to quantify.

At Saint-Maurice and Les Murets hospitals, studies predict an increase in demand for care and an increase in hospitalisations ( a 7% increase in activity for 2024 according to management). Psychiatric wards have been closed in Paris and the Val de Marne, putting additional pressure on the capacity to care for people whose needs have increased. People in psychiatric emergencies sometimes wait for several days in appalling conditions on stretchers in A&E departments, sedated and restrained. Our fight is part of the defense of asylum in the noble sense of the term. We are in favour of providing care in the community wherever possible, but we insist that a dignified treatment in hospital cannot be replaced. Nowadays, after the Covid pandemic, many carers are leaving public hospitals because of the bad working conditions and low pay. More than half of the posts on hospital wards are filled by temporary staff. Teams are chronically understaffed, and this state of crisis is becoming commonplace.

The patients we care for tell us just how much the current hospital premises, with their internal patios that allow them to walk around in a large enough space, are an integral part of the care they receive in hospital. Temporary staff tell us that they like coming to Esquirol because of the facilities. Some rooms are too small and need to be brought up to standard, but renovation work is possible while preserving the patios, activity rooms and communal area of the wards. Other types of care facilities that are sorely needed in France and in the region could be installed in unoccupied parts of this heritage-listed hospital, which have been abandoned for too long. 

Our struggle concerns civil, ecological and trade union aims. Our collective brings together carers, patients, elected representatives, environmental associations, trade unions and the general public.

Caregivers from the Esquirol collective (for the future of the Saint-Maurice and les Murets hospitals).

A petition is online to support us

All the latest news and information can be found on our website: https://collectif-avenir-hsm-murets.blogspot.com/ 

Contact: collectifavenirhsmmurets@gmail.com

 

Leaflet: Esquirol Hospital under threat – Join us in demanding its renovation!

On the 1st of January 2024, the Saint Maurice and les Murets hospitals (hospital site at 

la Queue-en-brie) merged, and are now called ‘Hôpitaux Paris Est Val de Marne’. This merger is accompanied by a development plan by the hospital’s management and the ARS (Regional Health Agency), which aims at selling more than half the buildings on the Esquirol site that currently house adult psychiatric inpatient services (26,000 m2 are under threat). These services will be relocated to two buildings to be constructed in a listed wooded area of the hospital grounds. A group of 110 beds on a surface area that is only a third as big. 

The project will be financed in several ways: renting out the ‘bas Esquirol to a lucrative private company for 50 years for the derisory sum of €0.86 per m2 per month; an increase in borrowing, now that the interest rates have gone up; and a reduction in the wage bill: we estimate that 240 jobs will be lost between now and 2036. Since the 1st of January and the merger, management has already announced 73 job cuts.

Since it was formed in May 2023, the collective for the future of the Saint Maurice and les Murets hospitals, made up of healthcare workers, patients, elected representatives, the CGT HSM and CHM unions, citizens and environmental associations, is fighting for the renovation of the current heritage buildings – in which Nicolas Philibert’s film Averroès et Rosa Parks by Nicolas Philibert were shot and whose major major assets are their open spaces, interior patios and large activity rooms. These inpatient reception areas are an integral part of care, and these buildings have been neglected for too long. (…)

At a time when politicians claim to be committed to the environment they want to fell 35 hundred-year-old trees, which will destroy an island of fresh air. The construction of the new buildings will close up soil and produce tonnes of CO².

At a time when the films of Nicolas Philibert show the humanity and care that is still possible in this hospital, let’s rally together against this destructive project and for dignified psychiatric hospital care.

We demand the renovation/modernisation of all Esquirol buildings and the future of all jobs.