We spoke to a friend in Germany who works as a nurse in a private hospital. While the general working conditions are not that dissimilar to our conditions in the UK, the private structure of the company makes things more complex. Our friend describes the privatisation process and how it impacted on their conditions. 

The company runs over 80 hospitals in Germany. In terms of collective contracts the workforce is divided into three different regional public sector contracts and various collective contracts that only relate to individual hospitals. The union focuses on those hospitals where they have most members and try to fight for better wages and conditions there, hoping that workers in less well organised hospitals follow the example. 

The company operates globally, it runs hospitals, produces medication and equipment. Actually we use a lot of the company’s products here at our two hospitals in Bristol. The company is also intertwined with private equity firms. Recently we have seen a steady increase in bankruptcies of these private equity healthcare companies, in particular in the USA. 

All this seems like a nightmare to many who are concerned about the health sector, but the lessons from Germany show you can organise as workers, even under these conditions, and be more active than groups or trade union branches in most NHS hospitals. It is interesting to read how the group started as part of the mainstream trade union and then had to organise itself independently.

 

How did you start working in health?

I left school when I was seventeen, which was partly voluntarily, partly because they said that otherwise they would kick me out. I then worked for a neighbour, who did gardening, putting down pavements and stuff. I started an apprenticeship as a gardener, but it was really shit and I left it. Two of my friends worked in an elderly care home, so I became more interested in that. I did a year as a volunteer at the local hospital. A friend encouraged me to do a nursing apprenticeship, but I lacked the required school education. So I started as an unskilled carer in a care home. I did a good job, but I got in trouble with the boss of the care home, who didn’t seem to like the colour of my hair. My co-workers really supported me and I realised that when you work, there are always problems, but there is also solidarity.

In the meantime they had started to offer training courses at the local hospital for my level of school education, so I did a one year course and then the normal three year apprenticeship to become a nurse. During the apprenticeship I met my comrade and we founded the first representing body for young workers with the trade union. Someone from the union came and asked us if we were interested in organising the young workers’ group. We said yes, and organised elections to choose the reps. We were pretty naive at the time. We first got some union training where we were told what we were allowed to do as apprentices and what not. That was useful, as apprentices were mostly used to just wash patients or to do other menial tasks. We not only had to push management to recognise the new representative body, but also the works council, the official representative body for all employees. At the time the works council did hardly anything. The technical school that we had to attend also didn’t like that we were now organised in some form. We did assemblies and surveys amongst apprentices. The living situation was one topic, most of us lived in hospital accommodation and this was a rather dingy dormitory, with a very strict manager. At work it was difficult to get actual training. On the intensive care unit they actually showed you stuff, on the normal wards you mainly washed people, today this is even more severe. Because of work intensification and stress, apprentices don’t learn much.

At the time the hospital still belonged to the county, in 2001 it became a share holding company, with the county as the main shareholder. I finished my apprenticeship in 2005, so we experienced the first phase of privatisation. Things changed quite dramatically then. When a private company became the main shareholder we founded a representative body for youth workers of the entire company group, which had several hospitals, something that had not existed in Germany before. By then we became too old, as you can only be an active representative up until the age of 25.  

What were the big changes in your work?

In the last twenty years my work as a nurse has changed a lot. They have decomposed ward teams, where everyone, from receptionist to nurse to cleaner feels part of a team. Some people just walk around the hospital and take blood, they don’t really have a team. They introduced outsourced departments for cleaning, re-stocking, transport and so on. Some nurses who have been there a long time become semi-managers of lesser skilled nurses. Patient numbers have doubled, a higher turn-over with more treatment, while we have less staff. The ‘flat-rate system’ has aggravated this trend, because if you release patients before the stipulated time that is allocated for a specific treatment, then you won’t get the whole amount. But if patients have to stay longer the hospital won’t get paid more! So the hospitals have a traffic light system for each patient, in terms of when it’s financially best to get rid of them. That’s crazy. Our light is always green. They discharge patients who are not medically fit. They also introduced a digitalised system for patient notes and drug charts, but without really explaining it to people, without good WIFI and with only two portals per ward! As someone who has been in the job a while I now earn 3,200 Euro before tax, for a 34 hour week.

How did the process of privatisation take place?

The staffing level changed. In 1998 we still had two nurses plus an apprentice plus perhaps a person on the national civil service scheme to take care of 15 to 17 patients. In 2005, when privatisation started, the county head said that there won’t be any redundancies, that on the contrary work would become more attractive. The private company then took over 74.9% of shares, the county kept the rest, so that they could still influence things to a certain degree. In 2009 this was reduced to 5.1%, which meant that they had no say at all anymore. In 2001 we were still 1,100 workers, by 2006 we were only 800. It is true, there were no redundancies, but we lost 300 people through attrition, primarily on the wards.

Your work contracts remained the same, you had to sign that you agreed that ownership would change. They also started to employ doctors through a separate company, outside of the collective contract, where they had to agree to a regular 42-hour working week. At that point the trade union was not present at all. At the time the hospital was still part of the public sector collective contract. In 2006 the union entered the scene, because now, with the privatisation, you had to negotiate a collective contract just for the hospital. Together with the privatisation we also had a national change in the health system in 2004, with the introduction of the DRGs (diagnosis related groups), a system where hospitals are paid a flat-rate for a certain treatment, no matter how long this takes. This means that the hospitals were forced to process as many patients as possible in order to make money: as much treatment as possible in as little time as possible. So on one hand we had now a company that just wanted to make profits, by cutting costs for personnel, which usually comprises around 60% of total costs in a hospital. On the other hand we had an institutional change within the national health system that encourages cost cutting and privatisation.

At the beginning patients didn’t feel the impact that directly, it was a slower process. Workers were rather unsure about the situation, the works council was overwhelmed, they didn’t know what all these changes meant, they remained very passive and just accepted things. Things started to move a bit when it came to the negotiation of a new individual collective contract. The new private hospital group always agreed single hospital collective contracts, not for the entire company group.  

How did the union emerge in this situation, as it had no base amongst the workers?

They didn’t get in touch with the workers, only with the works council. Usually most works council members are also union members, so that was their natural bridge, which also means that most works council members would sit on the negotiating committee for the collective contract. The union then invited workers to a staff meeting in 2006. We were too old to be official youth representatives, but we saw that we had to do something now, also because there were so many general changes at the time. For example in 2004 there were the Hartz4 reform or the so-called Agenda 2010, which would restrict your social benefits, and the Monday protest demonstrations against it. 

This motivated us to do more inside the hospital, to mobilise against these changes. We were still naive and had to learn that the mainstream union would betray us and take the piss. In the trade union youth organisation there were still some left-wing people, socialists of various kinds, they were a bit more open minded. The general union was an ossified apparatus, though. The union official who was sent to our hospital quickly realised that it was us who had more energy and impetus, so they asked us if we wanted to found a trade union ‘shop-floor group’ [Betriebsgruppe]. So five of us colleagues ended up starting this group. She tried to sell us the idea, by saying that we would be able to make our own leaflets and use the union’s official status. We had some experiences with distributing our own unofficial leaflets, but that resulted in quite severe repression from the management side. They even sent the cops to my place. We realised that we needed some kind of plan. We sent the draft for the first leaflet that we distributed as the official union ‘shop-floor group’ to the union secretary, but there was no response, so we distributed it. It was about the struggle for a collective contract, that we would all have to unite and struggle hard. The union went ape-shit. Management had contacted their lawyers and threatened legal charges. The local union official then got pressure from the top union people: “why do you let some wild kids write official leaflets?!”. The union then didn’t communicate with us for two months, they just dropped us. They wanted us to just distribute official stuff from the union headquarters, but at the same time they didn’t manage to do anything themselves. We think they told management that they stopped cooperating with us. We then said, “fuck you!” and signed our leaflets with ‘autonomous shop-floor group’.

We were still active in the union struggle for a collective contract, but not as an official union group. At that time the company group wanted to increase the weekly working time from 38.5 to 40 hours, which of course nobody wanted. This was a good starting point. At the next trade union meeting we handed out a leaflet concerning this change in working times, which was positively received by the rank-and-file, but at that point we were already outsiders. In the end there was no strike for the contract, it was resolved at the negotiating table. We managed to keep the 38.5 hour week, through the threat of industrial action. We had to find new ways of resistance. For example, one morning a six metre long banner appeared at the multi-storey car park of the hospital. We were looking for other forms of organisation. We read up on stuff that happened in Italy in the 1970s, in terms of workers’ autonomy, Porto Marghera and the network of autonomous factory groups. For example, we saw the autonomous social centre that we helped establish in 2005 as a potential part of the hospital struggle. 

What were the consequences of privatisation?

By 2007 you could really feel that the workload had increased a lot, for example, the apprentices were not offered permanent employment after they finished their course, which also contributed to the shrinkage of the workforce. In 2007 the hospital introduced the category of ‘service workers’. We managed to get hold of a management paper where they said clearly that they wanted to reduce the amount of registered nurses by two full-time positions per floor, there are two wards per floor. They wanted to do this by taking some of the nurses’ tasks, such as handing out food and internal patient transport, and delegate them to outsourced low paid workers. We saw this as a creation of a division within the entire workforce. Before, everyone on the ward was part of a team. During breakfast break everyone sat together, nurses, doctors, cleaners, apprentices, but that’s over. On the background of wider changes, meaning, the privatisation and the changes within the national health system, the introduction of the ‘service workers’ deepened divisions. It was not that nurses were arrogant towards them, but now you had someone below you within the hierarchy. Management actually managed to reduce the number of registered nurses, through a combination of fluctuation and replacement through the service workers. Things have changed in terms of work practice. Before you had to be careful when you fetched a slightly sedated patient from endoscopy, there was a certain protocol. Now it doesn’t matter, the service workers who do portering transport anyone, even if they are still unconscious after surgery.    

The three, four of us from the autonomous group were also still part of or connected to a small independent union, which decided that they wanted to start an exemplary struggle around this issue of the ‘service workers’. They started protest rallies outside the hospital, meetings, rallies at the local train station. A lot of media work. But we felt that it was a rather external campaign, it was for the sake of their organisation and we, as workers, didn’t control the campaign ourselves. We started to support some older cleaning workers who they wanted to get rid of. Even the work council advised them to accept a type of early retirement. We told them to refuse to sign and the hospital had to continue to employ them in the laundry, which still existed back then. They could work there together till they retired, and had a fairly easy job. These workers told others that we were the only ones who had supported them. We then had a certain standing amongst the service workers. Their first manager was mental, she tried to tell them which colour socks and underwear they had to wear. The wages were so low that you could not make ends meet. We started to communicate regularly with these workers. It was clear that the manager had to go and she had to go after she made the mistake of putting personal details of workers on public whiteboards, which is a breach of data protection. These workers liked us a lot after we helped them to get rid of the manager. And this is how people slowly came together. 

The independent group is established

In 2009 we started to work as an independent group. We started to organise monthly open meetings for hospital colleagues in a nearby cafe. At the time one of the wards, where some of us worked, turned a bit into a rebel ward. They really stood up for each other. Two colleagues from that ward joined us. We had already published one issue of a newspaper with the small union, so we decided to continue that as part of an independent effort. We wanted to publish what and how people on the wards were talking about their situation. With the experience that we had, we decided that a newspaper is better than a leaflet, as you can express more things and start an exchange with other workers. People told us stuff at work. At the beginning we could not act too openly with the newspaper, but on the wards we were relatively safe. The administration building is somewhere else on the campus. In a way it was clandestine, but we were like fish in the water. We were not too worried about being grassed up. We often distributed before the management arrived or after they left. We knew when it was safe. We circulated around 150 copies, but they were read by more people in the break rooms and smoker corners. We knew that we could not raise our demands officially at that point. People in the hospital did not refer to us as ‘the independent shop-floor group’, but by the name of the newspaper ‘Antigen’. 

The works council didn’t do much and the union was not present, so we were the only ones who talked and wanted to hear about working conditions on the various wards. People liked it, because we published in the way they themselves spoke. In the first issue we already raised some demands: for time in lieu for any overtime worked; for the possibility to take your breaks. We also gave people advice, e.g. that even if they owed hours, that they don’t have to work whenever management tells them to. At the same time we tried to link up with other shop-floor groups. A colleague from Hamburg contacted us, who had started the website: betriebsgruppen.de. She wanted to create a network of hospital groups in Germany. This effort was completely independent from the union. Some of the shop-floor groups were part of the union, but the union did not control the network. We went to many local care homes to inform people about the network. But it was not easy, in particular because the union officials spoke against it. So we ended up with only a handful of contacts, for example an independent group in Bremen. We still had the example of the nurses’ movement in 1989 in mind. One of our colleagues had taken part in it back then, when they coordinated primarily through independent local groups. Primarily the service workers came to our local meeting in the cafe, there was a core of ten people. We told them: “You guys don’t get any bonus payments for bank holiday shifts or weekend work, but we do. That’s not right. We should do something about it”. We started various initiatives, but high turnover, in particular amongst active workers, was a problem. We never had contacts amongst doctors, neither were we looking for them nor were they interested. This has changed a bit, now there is a bit more dialogue. The doctors were always amongst themselves, they wanted their career and accepted all kinds of things for that, like unpaid overtime. We always focused on the lower paid segment, most of us were nurses on the wards. 

The first warning strike

In 2009 there was an official warning strike and although we were not an official union group anymore, they let us hold a speech at the official strike rally because they knew we were a factor in the hospital. The union officials knew that our colleagues expected us to say something. Of course we mobilised for the strike, but the relationship with the union was broken. We were also critical of the strike, which was purely about wages. We said that what actually pissed people off were the bad working conditions and the cutting of the number of staff. We also said that for the union this was never a topic. Management responded with severe intimidation to the threat of strike, warning people individually not to take part. They tried to pay extra money for people who came to work on the day of strike, but that’s illegal, so they had to reverse it. At that point, neither management nor workers had any experience with strikes. Participation levels were not bad though.

On the days before the strike we distributed a leaflet explaining the right to strike as non-union members, as the union only focussed on its own members. We said: “A strike is for everyone”. At the time around 10 percent of all workers were union members. The strike was then strongest amongst the imaging and the physiotherapy workers, because that’s also the departments with union reps. Also the operation theatres, so in general the higher skilled workers, those who are a bit higher up in the hierarchy. This wasn’t really an expression of a strategy yet, e.g. to organise the strike in a way that it would hurt the company most, like closing the theatres,and a one-day strike doesn’t do much anyway. Not much money is made on the wards. The union was not much interested in the wards either, also because it is complicated, with minimum service levels and derogations and all. The guys on the wards were not happy, they felt excluded. This is where we focussed our effort. We told people that they have the right to strike, even if you don’t get strike money. We explained that they don’t have to tell anyone, whether they take part in the strike or not. Not so many ward workers went on strike in the end. We were also still practicing to be active at work. 

In 2010 we had a works council election, we said something about that in the newspaper. We also started interviewing people about their own struggle experiences in the health sector and wrote more about conditions in other hospitals. We took part in a kind of wiki-space, where people could exchange news, unfortunately it got hacked and content was deleted. That happened a few times. By that times the newspaper was published regularly every two, three months and somehow management put up with it. They roughly knew who was involved, but they didn’t attack us. We also tried to formulate things in a way that it would not be easy to tackle us in legal terms, e.g. by using phrases such as “some people might think that…”, but it was still confrontational. 

Further corporate changes

The other big issue was the intensifying process of privatisation. At the time there were three main private health corporations in Germany. From 2012 onwards the biggest company intensified its attempts to buy hospitals off its competitors. They tried to buy all shares of our hospitals too, but also a competing company bought shares that normally focuses on medical devices. The ‘regulatory board to prevent the formation of cartels’ initially ruled against a take-over attempt by the big company. In the end the big company managed to buy 43 hospitals of 53, many of them small ones, off its main competitor. Our hospital became part of this company in March 2014. People thought that their corporate identity policies were sect-like, e.g. you were not allowed to hang up any calendar with ‘Aspirin’ or other competitor products on it. The next thing they did was offer golden handshakes for the old upper management. They also announced that anyone who puts up material that hasn’t been sanctioned by management will be charged with trespass, which is gross misconduct and a reason for dismissal. That obviously targeted us. At the time we already organised info-stalls in town centre and articles in the local media, also openly using our names, where we warned about the consequences of the take-over. For example, the company had taken over a hospital company in the north of Germany and sacked 1,000 workers after they had voted in favour of industrial action. This stuck in our memory and we knew that we had to do something. 

Successful resistance against a new shift model

In 2014 we were in a good situation, because before the new company took over, the works council and management had agreed to a new shift-model, where you were basically on call for three shifts in some weeks. They would only tell you on short notice of one hour at what time you would have to start. Through solidarity and action we were able to stop them from implementing it. Various wards that were meant to be guinea pigs for the new shift-model joined together and wrote a collective letter that they didn’t want that change. They said: “We want to work less, not more”. That gave us a lot of confidence. We greeted the new company management with the news of our collective success: “Hello new company, there is resistance here”. We wrote a long article for the newspaper about this action. People liked it a lot. Shortly after the new company took over we wrote a leaflet for kitchen workers and cleaners, back then we still had a kitchen, with legal advice, given that management got away with a lot of illegal practices. These workers copied that leaflet and put it up everywhere, in lifts, in corridors. That got us in a lot of trouble with the new management. We had to re-consider safety. We decided to go into an offensive: putting up information like that cannot be illegal.

In early 2015 we wrote a reader’s letter for the local press about the repression and censorship inside the hospital. The problem was that one of the journalists said that they cannot print this article, but that he himself could write an article about the situation. We didn’t trust him much, so we said that he cannot quote us personally, but that he can use all the information from our leaflets and newspapers. What did the arsehole do? In the article he quoted us with our names. But he also asked the press spokesperson of the new company whether putting up relevant information inside the hospital would be prohibited and the guy denied that. He said it was okay, as long as the formal press regulations are adhered to, e.g. that the leaflets would be signed with the name of a responsible person. A former colleague, who didn’t work at the hospital anymore, gave her name for that – we used the address of the social centre as the official address. That meant that we had more space again to act more openly with the paper.

After the takeover the new company did not just change the leading management, they also showed early on that they would run the hospital differently. There was more stick and no carrot. They closed the outsourced hospital kitchen and sacked everyone, around 30 workers. They first ordered the food from a factory based in a different federal state, now it comes from a place close to Munich. There the food is cooked, then frozen, then driven to a different hospital of the company where they still have a kitchen, there low paid workers place the food on trays, then precariously employed truck drivers transport them to us, where we hand them out to the patients. They still try to portray themselves as environmentally friendly at the same time. Apart from the kitchen there were further changes, e.g. opening more hospital beds for specific treatments that make more money for them. They also outsourced the handymen of the facilities department to a subsidiary. They wanted 15% EBIT rates (Earnings before interests and taxes), which is mad. For a normal business 12% would be a lot, but for a hospital?! The new general manager of the hospital knew that if he didn’t deliver he would have to go. Most of these managers are really young, as well. They went through training programs that were sect-like. The size of the corporation helps them in terms of economy of scale. For example, the company has a global subsidiary which deals just with hospital architecture, which they can use when it comes to new buildings or renovations. They also have a subsidiary that was the world market leader for dialysis machines. Then they have a subsidiary that produces antibiotics, fluids, but also hardware, such as cannulas and IV systems. Then they are a holding that owns the actual hospitals, so they can circulate stuff in an internal market somehow. It is centrally organised, top-down. A local CEO has to go if they don’t make the expected profits. So since two years they form so-called clusters, where two or three hospitals share only one hygiene or IT department, for example. The sterilising department has been outsourced to a subsidiary. The cluster model also affects the clinical departments, for example, our trauma accident department doesn’t work very well in economic terms, so they reduced staff and beds there and shift them to a newly founded orthopaedic hip centre. Our doctors treat and surgeons operate on patients not only in our hospital, but within the wider cluster.

You told me that in your hospital in the NHS there are multi-national corporations that use their global knowledge to train ‘public sector staff’, for example, in how to use a new set of orthopaedic instruments or that they fund research projects. In our hospital it would be unthinkable that another big competitor company would take part in a surgery or train workers. They insist on their monopolistic status. There is somehow a circulation of knowledge within the corporation in terms of better methods, and they like to boast about these things. But that is often more show than actual dissemination of knowledge. On the level of general staff they are not interested at all in training, upskilling or continuous learning. When the CPR trainer handed in their notice they didn’t replace them, although they are legally obliged to do so. So there wasn’t any training for two years. All the obligatory learning modules, from data protection to infection control, that expire after one or two years… I haven’t done them in five years.They don’t give a shit about workers and patients. New people don’t learn the basics anymore. We tell our relatives “don’t go to these hospitals”.

Meetings for better staffing levels

In 2016, before the conversion of the building, we had wards with up to 77 patients, staffed with two nurses and perhaps two health care assistants. Things are still bad, but that was the peak, when we said this can’t continue. The union wasn’t there, the works council didn’t do anything, so we called for a public meeting. We invited the political head of the county who still held 5.1% of the share of the hospital for a discussion. That was in October 2016. That really had a big impact. Over 100 people came to the cafe where we held our monthly meetings that people had to stand outside. It was mainly workers, not patients who came to the meeting.  It was double as many people as any general staff meeting of the entire hospital has ever seen. There was a lot of media coverage, as well. All of a sudden we were part of the public discourse. This is a small town, everyone knows the hospital, has been there or had relatives as patients there. All of a sudden the bad working conditions at the hospital were a political topic in the town. We said “enough is enough, we need more people”.

Then all of a sudden the trade union reappeared on the scene. They referred to the collective contracts for better staffing levels that had been agreed on at the Charite and said that this is now a model for all hospitals. They also said that 2017 will be the year of struggle. They quickly backtracked and said that they will only include 13 clinics in the whole of Germany in the campaign. Because we were quite stubborn we managed to convince the union that our hospital should be one of the 13. I went to various union meetings all over Bavaria to encourage them to include us as a striking hospital. This somehow worked. We were the only private hospital on the list. But it took the union ages to get things going. In early 2017 we said “come on guys, we want to do something!”. But the union officials were very hesitant. They referred to the national elections in autumn as a strategic event. In autumn 2017 things finally started, that’s when they also introduced the team delegate principle. In April the left party Die Linke organised a meeting in town that referred to the hospital dispute. We were invited to that. We said there that with that management nothing will change and that we will need a hard industrial dispute. We said that in order for the media to use it as a quote. We took an uncompromising and confrontational stance. They listened to us despite the fact that we had no official union status. The union tried to increase their membership at the same time. In their logic ‘many members’ equates to ‘good industrial action’.

They started team delegate meetings. We, as a crew, decided not to be part of the negotiating commission of the collective contract dispute, but rather we make sure that we decide who becomes a team delegate. All of us were team delegates. We went through other wards and saw who would be a good potential delegate. We encouraged those people who colleagues pointed out as solid. In this way we thought we would have the  most influence over the dispute. Also non-union members were able to become team delegates. Some of us were members, others weren’t. In other hospitals the union just gave you the title of a team delegate, but at ours we decided ourselves who should be a delegate. There were joint meetings between team delegates and the negotiating commission. We had influence when it came to the organisation of the strike, but did not take part in the negotiations. We put forward concrete staffing demands for each ward. The negotiating commission needed us, so that they had actual numbers. We still did not want to get entangled too closely with the trade union and we thought that we could act externally, by embodying pressure and a mass of people, as delegates and as normal workers.  During the dispute we did not manage to publish a newspaper, we had too much on, we just circulated leaflets.     

The next warning strikes and union sellout

We then had a first day of warning strike in autumn 2017, then a second. The first day lasted from 6am till 6pm. The union first said that we should gather at 9am, in order to give people some flags, shoot the usual group photo, then go to a restaurant for a strike meeting and so on. We said “fuck that, we start at 6am with a picket line in front of the hospital”. There were no union flyers, we had to do that all ourselves, explaining the right to strike by another leaflet, also for non-union members, and the reason for the strike. So we somehow determined the content of the strike. The union couldn’t do much against that, because they needed us somehow. As long as the struggle was on, this strategy worked out. Later during the day we said that we would go to the union local, on the other side of the town. The union officials drove by car. We said we would walk. First people walked on the pavement, but we encouraged everyone to walk in the street, so it turned into an unregistered protest march. The apprentices really liked this, a young nurse stopping big busses, that was fun to watch. Other colleagues helped us to copy leaflets. We had to enter the hospital through back doors, officially we were not allowed to enter, but work-mates gave us hints where ward offices with copiers would be open.

Something developed, a kind of dynamic, a sense of self: “we are together, the union should organise what we want”. We worked towards this for years. We knew that once the new company takes over we would only be able to defend ourselves through strike. We also knew that we would need the fucking union for that. We were not so naive to completely trust them, but we thought that we could push them forward. The company said right from the start that they would not negotiate about minimum staffing levels. In order to be able to strike legally the collective contract had to run out and a wage demand had to be put forward, but we made sure that the staffing ratio was also on the agenda, because this is why people were discontented.

Also after the second warning strike negotiations did not progress. The union said that they will do a so-called enforcement strike, an indefinite strike, for which you need a ballot – 97.9% of all union members voted in favour. The strike was planned for early December. We were prepared and motivated. The company then went to the labour tribunal to get an injunction, claiming that the strike would put lives at risk, one day before the strike was supposed to start. The union called for a general strike assembly the following day, many people attended, at least over 30, including non-union members. No one was really surprised about management’s attitude and people said “Okay, let’s call for another strike, given that the injunction counts only for this dispute”. People thought that management was just lucky, that they had a sympathetic judge on the day who supported them. Or an inexperienced judge who took the statement of the three chief consultants, that the strike puts lives at risk, at face value. But the union officials said “tomorrow we have a round of negotiations scheduled, between the negotiating committee and management”. Everyone told them not to attend that negotiating meeting, given management’s attitude. “What kind of signal would that be, you first allow them to prohibit your strike and then you talk to them?!”. But the union officials ignored the wishes of the assembly and went to the meeting. The officials came back and told us “management has made a good offer, but we agreed not to talk about it for three weeks, we will announce it at a general meeting in the hospital shortly before Christmas. The team delegates will get to know details about the offer before the meeting”.

This was a political battle now, neither union nor management wanted to be seen as losers. The company tried to avoid a strike, because it would not be a good sign for their other hospitals. But they knew that workers were up for a fight, so how do you stop them from doing so? You provide an offer for the union, so that they cancel the action. The offer was, as it turned out, to join the collective contract of the public sector. That’s why we don’t have an individual contract anymore. The union said that this was not an agreement, but only a declaration of intent by management. The officials said “we won’t stop management from joining the public sector contract, it’s the Christmas break soon, we can still fight for a contract around the question of staffing levels later on”. What we didn’t know at the time was that the bosses’ side in the public sector dispute refused strictly to negotiate about staffing. The union just lied to us. In January they then told us “sorry, that’s actually not possible”. We knew that they would try to demobilise us, but what can you do in this situation? Formally we still had the result of the ballot in favour of strike, but no real agreement that you could vote about. The union therefore never formally ended the dispute, they just decided to do nothing instead. By February the thing was over. We criticised the union in front of everyone. In the meantime many people had left the union or even left the job. We started a petition, demanding from the union to accept the decision of the majority of the workers. The union called us a radical group that is just eager to stand in the limelight. They also said that the 130 signatures that we collected within a few days are not representative. It was a defeat for everyone. We needed till Covid to digest this defeat. We had connections to the trade union left, we formed an initiative together with them during the dispute, the whole left milieu from Munich turned up – but once the actual dispute was over they also disappeared. 

Independent activity in the works council

Officially the union said that now the works council could negotiate about staffing. That’s when we formed an independent slate and took part in the works council election. Personally I didn’t really want to do that, but the majority of our crew was in favour. We also continued to inform colleagues and the wider public about the results of other disputes, for example, we invited a striking nurse from Essen. The works council elections are weird, we had seven different slates. One slate from a nearby small hospital, then the official union slate, which tanked and came last. Then all the old works council members made their own slate, because then you definitely get in, even if you only have a few votes. Our slate and the slate from the other clinic got the most votes, but the way the distribution of seats is organised we only got 2 out of 15, so what can you do with that? They saw us as outsiders and tried to isolate us, just give us shitty jobs. As a works council member you get certain information. I joined the committee dealing with the economic aspects of the hospital. You get interesting figures and I really tried to familiarise myself with the matter, but officially you cannot publish the information. But some works council members find ways around that. I had to go to court because they charged me with divulging company secrets. But they were not successful. We also founded a committee ourselves, for better staffing levels, mainly trying to use the health and safety regulations to enforce better staffing. We are still trying this, after several years, so you can see how much or rather little impact the works council work has. I left the economic committee in the meantime, because there were too many snitches, who passed information on to management. You have many opportunists, people who like the gravy train. But we achieved little things, for example, we could prove that the main nursing manager provided us with falsified figures when it came to staffing and personnel planning. He actually lost his job over that. Being a works council member didn’t really alienate us from other colleagues. Most colleagues know that we are one of them, they come to us directly, rather than going to the works council office. But the legal system sets clear boundaries, clear limits to what you can do. I am still a works council member. I think the company would have been able to sack me a long time ago, if it wasn’t for the legal protection of being a works council member. In 2022 we tried to do more within the committee that plans the shift rotas for all workers, theoretically you can refuse certain shift plans and challenge them in court, if you think they are not safe. I also went to the general works council meetings, every two months, where people from all hospitals of the company gather. But I left that, because it’s too much work and the type of people you meet are primarily those who like to talk about the hotels where we meet. 

Covid

Then Covid hit. When it started in Bergamo we thought “oh fuck”. The first patient in Germany was treated in a nearby hospital, so-called “patient zero”. The hospital management did nothing in order to prepare us for what was coming. They didn’t check stock levels of PPE, they continued all planned surgeries, not a single bed was left in reserve for possible Covid patients. The first cases arrived in early March 2020, then they quickly kept one part of a ward as an isolated Covid unit. You were paid 40 Euro a day, before tax, if you worked in direct contact with Covid patients – the other workers on the same ward didn’t get that money. There was no critical workers’ base left after the strikes two, three years before, because so many people had left the job after we lost the dispute. Still, workers saw that management was not reacting appropriately to the crisis.

We knew that we work in a hospital, that we cannot run away, we have to continue, we expected that we might die. There was solidarity amongst ourselves. We know how to deal with infections, that’s our job. We published a statement as an independent group, we knew that no one else would do anything. We demanded PPE, the cancellation of all elective surgeries, anything that is not immediately necessary. We knew that we needed space. We didn’t give it to the media, but circulated it online, also within many local mailing-lists and on Facebook. At the same time the state attacked us, by changing the working time regulation, so that they can force you to work longer hours, have even shorter breaks. They also cancelled the minimum staffing rules. People were pissed off about this. A few days after our statement the first surgeries got cancelled. Of course not only because of us. All this happened within three weeks.

Then, on the 1st of April a new hardliner took over as CEO and his second was already in command. The following day a feminist collective organised a solidarity action outside of the hospital: because there were not enough masks inside the hospital they sewed masks for us and handed them over, as a symbolic act, you couldn’t actually use them inside. A colleague and I received the masks, there were pictures on social media. Management reacted by ordering us to an investigation meeting. At peak Covid they organised such a repressive meeting to victimise us, alleging that we had “embezzled a gift to the clinic”, which would be gross misconduct and a reason for direct dismissal. They asked all kinds of questions about us and the feminist group and so on. I wrote a complaint to the works council, the works council agreed that it was not clear what management’s intention was with the investigation. So they dropped it for a while. Then they ordered us to a meeting with the CEO, but they didn’t tell us what it was about, so we left the meeting immediately, saying that we were not prepared for discussing anything. Such games continued from then on. A day after the solidarity action with the masks the hospital was put in quarantine, which is unrelated. The state said that there had been cross-infections amongst patients and staff. The only other clinic that was put in quarantine was, not by chance, also a hospital owned by our company. There was a lack of tracking and testing when receiving new people, many of our colleagues caught Covid from a particular ward. The quarantine was heavy, because it had to compensate for previous negligence. The local health authorities banned all hospital workers from leaving their house, apart from going to work. Even if you cycled in you had to wear a mask. We were not allowed to use public transport. We had to stand in a queue of a hundred metres to get tested – and we had to fight that this would be registered as official paid working hours. We documented all these events during the first weeks of Covid as a chronology in our newspaper. We knew that this was a disastrous series of events. This newspaper issue was our masterpiece, somehow. 

There were discussions amongst us about how the state reacted to the pandemic, how the medical management reacted. But there were too many insecurities, we didn’t know if they would turn the hospital into a military lazarette type of place the next day. There was little space to develop an organised public or alternative discussion about how to deal with the pandemic. There was something like a critical counter-knowledge, for example on intensive care units, where they saw that preventive intubation doesn’t make sense in this situation. But the critique from workers in these units remained on the level of “there is a lack of FFP3 masks”. Still, the bosses also realised that there is a lot of discontent building up, in general. There were a load of discussions, for example, once certain people were sent to work remotely from home office. These discussions were amongst nurses, amongst cleaners and apprentices, about what type of work is important. This came at a point where we were publicly hailed as heroes. We knew that society couldn’t do without us, in general, not only during the pandemic. We talked about how society functions, about what type of work is essential and the way it is done. I haven’t experienced something like that before.

By May wards and beds were opened again in the hospital, elective surgeries restarted. We still had to wear masks, we often had to wear the same FFP2 mask for a week, because there were not enough of them. All in all, people came out of this situation beaten, rather than strengthened, as a collective. Also because it was a constant up and down, with the next wave of infections in November, another lockdown. With Delta and then Omicron we often had to transfer patients to other hospitals, with army support. Because there was not enough capacity in our hospital. It fucked us up, somehow, rather than making us stronger as a workforce. We saw ourselves as the door matts of society. Some of us paid with their health.There were no fundamental changes within the health system, which a lot of people had hoped for, us included. As soon as they could, management was on our backs again.

Even during Covid, they intensified the process of installing ward managers who were loyal towards them and who acted as informants. As long as you were loyal to management, you could get away with anything. We got embroiled in trying to save our asses and had to act clandestinely to continue with our newspaper. We ceased circulating multi-page papers, we shifted to double page leaflets, also because the boot-lickers started to collect and get rid of them immediately. We started a series of survey leaflets, officially through the works council, but which had agitational character and were plastered all over the hospital by god knows who. It said things like “we are overstretched, but we are not daft”. The survey was meant to instil the spirit of “now it is us who say what we need” and a sense that everyone should take part in it, disregarding department or profession. People liked it! A five-metre banner appeared outside of the hospital again, with demands, but that wasn’t done by us. At the same time, the state’s ban on public gatherings meant that strikes were prohibited, too. We criticised that publicly as an attack on our rights as workers. We had a public protest in June, where we kept a certain distance between ourselves, where the police cordoned us off, but where we also got a lot of sympathy from the public, who actually joined our action. 

Management later on used the pandemic for restructuring the work inside the hospital. They focussed even more on those wards and theatres that made money for them, they swapped many wards around. People had to shift from one week to the other. Normally these things need longer-term planning, but there wasn’t any. People need training if they are sent from cardiology to respiratory, but there wasn’t any. The neurological ward was turned into an urological one without staff being re-trained. They closed the sleep-lab, because it doesn’t pay, and stuffed more urology patients in. They opened a clinic within the clinic, for high-end patients, who paid double for their special treatment. The state introduced another factor into management’s profit calculation: during Covid the hospitals received 500 Euro per day from the state for each empty bed, reserved for possible Covid patients. The company doubled their profits in 2020, partly because of these subsidies. In September we started some workplace actions again, when it became possible. We called them ‘active lunch break’, somehow related to the survey. We are not allowed to call for a strike, only the union can do that. We wanted to use our statutory break in order to protest in front of the hospital, because you are free to do what you want during your breaktime. Part of the active lunch break was a display of all official complaints of only one ward about understaffing that had been issued by colleagues during the last year. These complaints are a bit like Datix reports. We filed these paper forms on a long string and encircled the whole protest gathering with it. Gimmicks for the media! In September 2020 around 50 people took part during their break time, apprentices, nurses, physios, no doctors, of course. A union guy also came to speak, but no one listened. Staffing levels and the bad treatment of workers and patients were the main issues that were raised. And that management tries to intimidate people. 

‘Active’ breaks and other forms of struggle

Since then we tried to change our tone a bit, we speak less of us as victims. We stress that we are powerful. In 2021 the trade union also called for ‘active lunch breaks’, but only 20 people came, including us, who came to see what happened. During that union action we unrolled a big banner from the car park, saying “we only get what we fight for – no redundancies, no work stress”, the union didn’t like it, but the media was happy to show something. In 2022 the big hospital strikes in North-Rhein Westfalia started. Colleagues in our hospital asked “why are we not allowed to do that?”. But people were just pissed off with the union, it didn’t go beyond that. We had one situation where on a particular ward there were many people off sick, and we knew that if more people called in sick they would have to close that ward officially and call off certain treatments. We used this for a sick-out action, management suspected that it was deliberate, they had to close the ward for three days. This cost them more than a one day official union warning strike. We were not able to attach any demands to this, because it is illegal, and we also decided against reporting about it in our paper. But management knows what the general problems are and what we want. I should add that some colleagues didn’t like the action either, because some patients were transferred to their wards. I guess these types of occasional actions would have to rotate somehow. A rolling stoppage. 

So we have a complicated picture. We had the disappointing strike, followed by Covid. These were two blows for us. But then there is a general increase in strike activities in the health sector, in particular in the US, but also Germany. People talk about the Care Revolution, the left scene is interested in discussing these social conditions. We wanted to go beyond our own hospital, somehow. We wanted to talk more about examples of struggle elsewhere. But things didn’t become easier. In 2022 we did ‘active lunch breaks’, but only 30 people came – and there was a counter-action, also with 30 people, who were loyal to management. Or rather, 5 of these people were loyal and 25 were from one of the wards where predominantly migrant workers work. They had been told “come to a photo shoot!”, they didn’t know what the action was for and how they were being used. Some of them were pretty pissed off afterwards. From May 2022 onwards the management and CEO started to invite me to various investigative meetings. Every two months, they asked whether I wanted to leave the job and offered money. This intensified. 

In February 2023 management wanted to dissolve the transport department and the department of ‘service workers’, those who bring food and do internal transport, which they had outsourced in 2007. They wanted us nurses to do that work again, because in 2021 the wages paid to care staff was excluded from the ‘flat-rate per patient treatment’- system, meaning, all wages paid to care staff were reimbursed fully by the health insurances in order to encourage hospitals to hire more staff. All of a sudden guys working in patient social services or as secretaries are also declared as care workers by management! So management had an interest in taking these basic tasks away from the low-waged non-care workers and sacking them. Officially they didn’t say they would sack them, but they would ‘upskill them’ and offer them one year courses to become a health care assistant. This is also because from 2025 anyone who works at a patient’s bed has to be officially qualified. But that ‘upskilling’ was phony – most of the service workers were not in the position to complete such a course, also because of language reasons. So in the end they actually made them redundant, and now I spend more time handing out food or bringing someone to X-ray than doing care work or joining the doctors on their round. I hardly ever wash patients, there is just no time. There are more complaints from patients’ relatives, but they don’t reach the top. Four out of fifteen 15 nurses on our ward have handed in their notice in the last two months. There are plenty of easier jobs. 

We still managed to collect 100 signatures against the redundancies and countered with our own demands: if you come to work on your day off, you are entitled to take that day off another time within two weeks; if you are sent to work on another ward without notice twice within four weeks you should be paid 25% extra (50% if it happens four times); if they ask to change your shift within the current rostered working week they should pay 25% extra for that shift; if they don’t manage to keep within the required staffing level they should give you one extra holiday for every three months; an end to the situation that people can’t take their breaks, documentation of any break that could not be taken. These are very basic demands that management could fulfil immediately. We also took on the demand of physio apprentices, who are not paid, but get meal vouchers – after canteen prices had risen they could not afford a full meal with these vouchers, so they went to the main manager together, asking him to increase the voucher by 1 Euro 20, but he refused. After we published all these demands shit hit the fan. Within two weeks I was invited to a meeting with the CEO and HR management. They shouted at me for one and a half hours, and verbally abused me, provoked me. They said “you won’t have a single calm minute at work anymore, we will find something to get rid of you”, “we made you an offer last time, either take the offer or your life will be hell”. Never go to such meetings alone, leave the meeting if they haven’t told you in advance what the meeting is about, don’t let them provoke you. They always tried to find mistakes and errors in my work, but my head nurse and my colleagues always stood up for me. 

The future

I don’t know about the future. I don’t think we will ever go on a real strike, not with this union. I also don’t want to take over the works council and become some person on full-time release. But there is a lot that we have developed for ourselves, a sense of togetherness. New workers arrive, perhaps they bring struggle experience from their countries. More than half of the workers on our ward are migrants. In the 1990s there were people from ex-Yugoslavia, in 2016 many refugees from Syria and from African states came, while agencies recruited directly from the Philippines. We now have more workers from Tunisia, but they were too young during the Arab Spring. They also hire many people from Brazil. The workers who arrive now get a one-year right to reside, which is connected to their work contract, which is also limited to one year. That makes it hard for them. They are supposed to finish their qualification in that period. Just to get the papers that are necessary to apply for a one-year training course can take 6 months and that paper costs you over 100 Euro. During that time you are really dependent on your job, because if you leave it, you might lose your right to reside, too. Now 70 to 80% of all new apprentices are recent migrants. They bring new experiences and we have to widen the scope of our initiatives beyond a single hospital.