We translated this report because it goes beyond the usual ‘mobilising’ strike announcements, but instead provides a little more background. In the near future we will try to write up further thoughts on the Berlin hospital strike, including a critical reflection on the trade union strategy, based on conversations with local health workers. You can read this article to understand the wider context. Despite various limitations, e.g. a strike participation of only around 20% (also due to legal emergency cover), we can still learn a lot from our fellow workers in Berlin – in preparation for future disputes here in the health sector in the UK.
Original article here
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Introduction
On the 23rd of August 2021, workers of the Berlin hospitals Charité and Vivantes went on a three-day warning strike. The strike included the outsourced service workers at Vivantes. This was preceded by an ultimatum of 100 days, which the Berlin Hospital Movement (an alliance of initiatives and unions) had issued to the Senate (local government) and the employers of the state-owned hospitals on the 12th of May. The trade union demanded a serious offer concerning staffing levels, so-called ‘relief’, and pay and conditions according to the collective agreement for the public sector (TVöD) for all employees of the outsourced subsidiaries. The Senate and employers let the time pass unused – the health workers made good on their announcement and went on strike. Vivantes initially had the walkout banned by a temporary injunction from the labour court. The reason given: The medical care of patients was not secured because no emergency service agreement had been settled between Vivantes and Ver.di (the responsible trade union) in the run-up to the strike. However, the injunction was overturned a short time later at the labour court, and the walkout at Vivantes could begin.
In the meantime, it is clear that the strikes will continue. Today (6th of September 2021) Ver.di published the results of a strike ballot: about 98% of the union members at Charité and Vivantes voted for further work stoppages.
These latest disputes continue a long-standing movement for more staff and relief at the hospitals. The struggles at Charité played a pioneering role in this (for the history, see the Ver.di brochure “If there are more of us it is better for all”). Following on from the Berlin experience, a movement for a collective ‘relief’ contract, which would allow for better staffing ratios, also formed in the region of Saarland from 2017 onwards. In these movements, strikes were held on the basis of emergency service agreements in which the employer was given responsibility for patient safety. Another novelty was the model of ‘collective bargaining advisors’ or team delegates. These delegates, which are supposed to be in close contact with the team nature of day-to-day work, should create a strong feedback loop between the collective bargaining process and the ran-and-file on the shop-floor.
We talked with Anja Voigt about the latest struggles. Anja is an intensive care nurse at Vivantes, involved in the Berlin alliance “Health not Profits”, Ver.di member and part of the collective bargaining commission.
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Communaut: Before you went on strike, you gave the senate and the employers a hundred-day ultimatum so that they would make you an offer for a collective agreements. Since there was no movement at all on their part, you now went on a three-day warning strike. How did you decide to use the ultimatum as a means of struggle?
Our thought behind it was that the time was ripe for a renewed fight, since nursing and the hospital have received a certain amount of public attention through Corona. In addition, in September there is the election for the House of Representatives in Berlin. So the months from May to September were a good timeline to put pressure on politicians. If we simply stood up and demanded a collective agreement on relief, probably no one would have noticed. That’s why we tied the demand for a new collective agreement to an ultimatum, saying, “If serious negotiations don’t start by the end of the ultimatum, we’re going on strike.”
Did the idea of the ultimatum come more from the union side or from the workers?
The idea came more from the union, but really only the idea. A lot of colleagues were involved in the whole implementation, who in turn asked their colleagues: “Do we want to do this? Is this something that can bring us success?” The idea alone would not have been enough. When we asked our colleagues if they would take part in industrial action, they were beating down our doors. They were really up for it. The pressure on health workers is now so great and it’s clear to everyone that things can’t go on like this in Berlin’s hospitals.
Does that mean that there is currently a high level of support for the demands and a high level of participation in the strike?
Yes, there is a very high level of support. We started with a petition to find out whether our colleagues wanted to take part and whether the demands were important to them. More than 8,500 colleagues signed the petition. The approval of the demands for relief (better staffing levels) was also clear in the last TvöD (collective contract for the public sector) negotiations in October, when Ver.di asked what we would like to see negotiated. It emerged that many colleagues are no longer interested in a pay increase, but in more staff. More money is nice, of course, but it doesn’t solve the current problems. On the contrary, the current workload is causing more and more people to leave the nursing profession. In order to stop this, fundamental changes must finally be made.
How do you organise yourselves on the hospital level and, above all, between the various hospitals?
Initially I was unsure if a simultaneous struggle in two hospitals would work. I had doubts about whether it could work. Vivantes alone has nine different locations, the hospital campus is vast, while Charité has three large complexes. Nevertheless, we wanted to bundle our demands and develop a joint movement. I have to say, it’s working brilliantly. Social media are wonderful for such purposes, especially telegram channels, etc. We are much better networked today than we were during the collective bargaining disputes two years ago, which is really impressive. I suddenly know colleagues from the Benjamin Franklin Hospital or from Spandau with whom I had never been in contact before. Now we know each other and are aware of each other’s problems. The greater networking also leads to enormous cohesion between the colleagues, which of course also makes us stronger. I haven’t experienced that in recent years – and I’ve really been active in the union for a long time. A really strong movement has emerged. You can also see this in the fact that – albeit slowly – small success are becoming visible. We can move a lot due to the size that we have now.
Is your networking ‘only’ digital or do you also meet in person?
Of course we also meet in person. That’s very important for the exchange of ideas. But it’s striking how much easier communication has become thanks to social media: In the past, if there was something important to communicate that affected everyone, in the worst case we would write a newsletter. It would then be on the road for half a week until it reached the last area. Some people didn’t receive the information until 14 days later. Today, you send something to the telegram group and 5,000 people know about it immediately, which is a great relief and makes union work much more interesting for me, because you can reach so many people so quickly. That’s really fun.
How did you come up with your demands, is it more top-down? Are they Ver.di demands or do they come from below through your networking?
No, it’s not top-down at all, quite the opposite, it starts at the bottom. We have started – very laboriously – to talk to every single colleague. In their teams and on their wards, colleagues asked other colleagues. In this way, each colleague conducted a so-called demand interview, in which they were asked what their work situation was like, what was stressing them, what was needed to improve the situation, what was needed to reduce the workload, and how many staff would be needed to do a good job and to be able to care for patients well. We then gradually bundled the demands that were mentioned in the hundreds of interviews and used them to draw up systematic demands. Nothing was dictated from above.
For some years now, Ver.di has had a system of team delegates for labour disputes, here in Berlin and beyond. Can you describe how this works? Do workers have more of a say vis-à-vis the union leadership than before? How do you see the relationship between union activists and Ver.di in general? Ver.di has not always covered itself with glory in the past – for example, during the Charité strike.
This is now a very broad and democratic process. What I have just described with regard to the demands also applies to the feedback from the other side. You can think of it roughly like this: A ward has about one to three team delegates, depending on its size. On the one hand, these team delegates maintain the connection to the collective bargaining commission, i.e. directly to the main Ver.di office, and on the other hand they feed all the information back to their team. It is no longer just one person from each hospital building who sits on the collective bargaining committee and has to establish a flow of information to the entire workforce, but there is now a direct link between ward teams and the main office. For example, we have a meeting of the collective bargaining committee today and afterwards, at 5 p.m., there is a Zoom meeting with all team delegates from Vivantes and Charité. We then report to everyone what happened today and what we have planned. The team delegates then have the opportunity to give us feedback. So it’s not just a one-sided address from us and then the meeting is over. If the team delegates say they don’t agree with what we agreed to in the bargaining committee, then we don’t do that either. We don’t even make important decisions without this feedback.
This system of team delegates makes a lot of the female colleagues feel more involved. They no longer have the feeling: “Now we’re back to collective bargaining and Ver.di will say what’s going to happen, and then we’ll stand there with a flag and go on a warning strike and it’ll be fine.” Instead, they have the feeling that what is important to them also reaches the union and is negotiated directly. It’s about their needs and the needs of their patients on the ward. That’s what makes this movement so special.
You are currently fighting two battles at Vivantes at the same time: On the one hand, the nursing staff fights for the collective ‘relief’ agreement. On the other hand, the outsourced workers of the Vivantes subsidiaries fight for the integration into the collective agreement for the public sector (TVöD). How did you manage to combine the two struggles? That’s sometimes a difficult thing to do.
Yes, that’s incredibly difficult, especially to make sure that the struggle remains simultaneous. But it was important to us from the very beginning to make clear that we are one hospital and that everyone in this hospital works together. That’s teamwork. The nurse is no better than the cleaner, the handyman or maintenance person no less important than the radiographer. Only together can we provide good patient care. It’s really special that we’ve managed to bring so many people with different demands along with us. At the moment, the nursing staff is fighting for a collective agreement to reduce the workload, the subsidiary workers would finally like to be paid fairly, and yet we are fighting together. We also hold joint collective bargaining committee meetings and exchange information together digitally. When the management of the subsidiary company comes up with a new offer to negotiate, we are invited to join in and discuss it: “You want to go on strike now, it doesn’t really suit us right now, but we can support you.” That’s always a very productive exchange. I find it very inspiring. It creates a close cohesion within the hospital. Suddenly you say hello to the cleaning staff early in the morning, who you didn’t even notice before. I also find it impressive that at the strike demonstration last week, colleagues spontaneously took to the stage and spoke in front of 1,000 people who no one else would have noticed. All of a sudden they are visible in their function and position.
Can you assess how the willingness to fight has changed as a result of Corona? Have you noticed any changes compared to before?
This bad situation in the hospitals existed before Corona, of course, but it has become even worse, the workload has increased further. In addition, there is the factor that I mentioned earlier: We got more attention and publicity because of Corona. It makes the fight easier when you know that many people and the general public are behind us. I also believe that the willingness to fight has increased again as a result of the stupid applause. Many of us felt fooled by it and now say, “You can stop the nonsense, we really want a change now and now we’re going to do something.”
At the Charité, and also at other public hospitals, the strikes of the past years were based on the regulation of a so-called emergency service agreement. This plays a relatively important role in the enforcement and organisation of strikes in hospitals, and in your case there has even been a court case. Can you explain what exactly an emergency service agreement is and how it comes about?
The concept of the emergency service agreement was first developed during the big Charité strike in 2015. Until then, there were virtually no strikes in hospitals. Maybe people from reception occasionally engaged in symbolic pickets but otherwise it was always said: “We can’t go on strike because our patients won’t be cared for.” This led to great frustration among hospital workers. As a result, the union at the Charité came up with the emergency service agreement system. With this agreement, the union gives the employer sufficient notice that they want to strike. The employer is then responsible for ensuring patient care. To put it bluntly, the emergency service agreement says to the employer: “We won’t be on the ward tomorrow morning, so make sure that there are fewer patients.” This makes it possible to delegate responsibility to the employer, which is why this emergency service agreement is so important. In the meantime, hundreds of such agreements have been concluded in many hospitals in Germany. In the meantime, however, it is no longer quite so easy to enforce. In the past, it was a matter of settling an emergency service agreement for three warning strike days. Today, and especially in Berlin, we are no longer talking about just three days. The employer also knows that and naturally says, “No, not with us.” It is no longer enough to simply indicate that we will walk out. There are now negotiations back and forth and in the end the employers don’t want to settle for an emergency service agreement. But then we go on strike anyway because it’s our right and we have an emergency service agreement in place that we abide by. This means that our patients are not at risk. This has now also been confirmed to us in court in the current dispute.
At the beginning of this warning strike, Vivantes first managed to enforce a ban on strikes by means of a temporary injunction. What would you say was the strategy behind that?
The employer’s strategy was quite simply to prevent the strike. But it didn’t work; on the contrary, it backfired for Vivantes. During those three days, the willingness to fight grew even more because people were angry. The employer shot themselves in the foot, and I don’t think they expected this. We were proven right. It was also very important to many colleagues that we were not deprived of our basic rights just because we work in a hospital, but that it is clear that you can also strike responsibly in a hospital. It also annoys me in the public debate when people act as if we were irresponsible. None of my colleagues walks out, drops everything and we’re gone. We always check to see if someone else is there to do the necessary work. And we agree: “If you stay, I’ll go out, tomorrow we’ll do it the other way around.” That goes without saying. We took on so much responsibility in the Corona crisis, we didn’t run away. Of course, we won’t do the same in the event of a strike.
When the strike at Vivantes was hanging in the balance, did you discuss among yourselves what you would do to get around it if the strike ban remained in place?
The first moment the order was announced, we were all shocked. Then we quickly regrouped and thought about what we would do now. It was clear to us very quickly that Vivantes would not be able to get this emergency injunction through. A judge had decided that in a rush, but we knew that we had a good emergency service agreement and that we would get justice in court. And with this conviction that we would win, we went to court and won.
The managing director of Vivantes, Johannes Danckert, likes to emphasise that he is also in favour of relief agreements, but that one hospital alone can’t do anything and that more money and, above all, political solutions are needed at the state or federal level. How would you answer him?
I would tell him that he is absolutely right. The hospital financing system urgently needs to be reformed. Political solutions are needed, no question about it. We’re all with him on that, and we’ll also join him in the streets to demonstrate for that. But in the current situation, it’s up to Berlin’s state politicians, and we’re putting just as much pressure on them as we are on the management. We are always told by the management that they can’t decide anything and that the money has to come from politics. But we talk to them just as we talk to our management. As a city, as the capital of the Federal Republic of Germany, we have to think about whether we want to provide good services of general interest, healthcare that is fair to everyone, patients and employees alike. If you want that, then you have to spend money on it.
Now there is an emergency service agreement. How many employees were ultimately able to take part in the warning strikes and demonstrations?
There were 2,000 people at the strike demonstration on Wednesday. That was very impressive. There is still no emergency service agreement that Vivantes would have accepted. There is one that we say is good, that the employer could sign at any time – but they don’t, although it has also been confirmed in court. Nevertheless, many colleagues can go on strike with this emergency service agreement. I can’t give exact figures now, but certainly half of the colleagues were able to take part in the strike.
Only nurses and other staff went on strike: what is your impression of the doctors? Do they support your demands and the strike?
It always depends on the level of the hierarchy. The assistant doctors, i.e. the medical colleagues who work directly with us, see our daily misery and therefore support the strike. There is even a medical petition that many doctors have signed – including chief physicians or senior physicians, i.e. people in management. They also know that they cannot fully occupy their beds because there are not enough nursing staff. They don’t often say this so openly because they are also under financial pressure and sit in management positions. One question that always gets me is why we don’t all get together, from the nurses to the head physician – or even the management – and put our foot down and say: “This simply can’t go on any longer. Something is financially sick in Germany’s hospitals.” We still have to get that together.
In Berlin, there is also a lot going on, also outside of the hospitals. The railway workers, who also work in the public sector, have gone on strike; at the delivery service Gorillas, there were so-called wildcat strikes recently; there are protests against the expansion of the autobahn – are there mutual references and solidarity between these struggles?
Yes, there are solidarities. Just a short while ago, we were at the AWO (charity and big care employer) workers’ strike with our collective bargaining committee. Colleagues from the GDL (train drivers union) visited our strike. We are networked among ourselves and there is support everywhere. Sometimes it seems to me that a lot is happening here this summer. In Berlin, people are setting out to fight for a better city.
During the first Corona wave, there was a lot of talk about care work and the poor working conditions. Do you feel that there is more solidarity and understanding for your demands from society than during labour struggles before the pandemic?
In my perception, people have always had understanding. They just could never understand how you can go on strike in a hospital. Many were afraid that we would simply leave the patients behind. I think something has actually changed. For example, when I was standing in front of the hospital’s strike picket during the warning strike, an elderly couple came up to me and said, “It’s right that you’re on strike, that’s a good thing. They canceled my X-ray appointment, but that’s just the way it is.” I have the impression that the population knows that something has to change. People also understand that they have to actively fight for change and can’t always just start a petition. They understand that sometimes you might have to confront people head on in order to change something. Then a medical appointment might have to be postponed sometimes.
Now you have carried out the warning strike. What do you think, will the hospital management come to the negotiating table? And will the workers vote for an indefinite strike in the ballot on Monday?
In any case, you can see that our pressure has been successful and that something is moving. In a meeting with Vivantes management today, they used the word “negotiation” for the first time. That’s more than they did three weeks ago. It’s still not concrete, because the management hasn’t made any proposals yet, but at least they are now signalling their willingness to sit down at the table with us. But we need to keep up the pressure. We can’t let up now, we have to step it up a notch if we really want to achieve a positive result. I am very sure that the ballot will be positive and I assume that around 90 percent will vote in favour of a strike.
The demands that were at stake during the ultimatum and the strike concern collective bargaining issues. However, there are a number of demands that go beyond this, for example in the ‘Health not Profits’ alliance, in which you are also involved – such as the abolition of the fee-per-case system and your demand for a solidarity-based healthcare system without profit logic. What could such a healthcare system look like and what would have to happen for it to actually be implemented in practice?
There would have to be a different financing system. In the entire health sector, both in hospitals and in outpatient services, rehabilitation facilities, nursing homes, etc., the focus should not be on competition and profits, as is currently the case. No fire department, no school, no library has to make a profit, why then in the care of the sick? Something is ethically wrong. What is needed should be financed. If I’m sick, I need treatment, and that needs to be fully financed. The state must pay for this financing. We would not deny that it is also possible to work economically. But care must not be linked to whether an operation is particularly lucrative, and it should therefore not be prioritised over other cases. It cannot be the case that financial considerations determine how one is treated. We still have good medical care in Germany, but profit orientation absolutely must be abolished. Nor can taxpayers’ money and health insurance contributions be used to finance a system in which, in the end, some shareholders can pocket profits. That is crazy.
Do you think that such a health care system is possible within a capitalist society? Many people say that housing should not be a commodity – and why should food be a commodity? But in fact, almost everything around us is a commodity. Do you think that a needs-based supply is possible within this logic and that the state will simply step into the breach?
I’m quite sure of that, because that’s how it was in Germany until 2003. Until then, at least, the hospital financing system was not based on competition, but on need. Of course, there was a lot of corruption and abuse of power. But at least no hospital had to make a profit and be in the black. If the will is there, it is possible to turn this around again, perhaps not overnight, but as a trend. Even within the German Hospital Association (DKG), there are already such efforts. It is also clear to them that things can no longer go on as they are now.
Another of the alliance’s demands is an equal distribution of care work between the sexes, whether private or professional, instead of cementing it as a task for women and families. Could you elaborate on what you mean by that exactly?
In our society, it’s clear who provides care: 70 percent of the people who work in hospitals are women. In the private sector, in the domestic care sector, their share is even higher. It is a task for society as a whole to rethink this. This starts on a small scale, for example with parental leave. How many men take parental leave these days? There are still very few, even though more and more are doing so. There needs to be a change in thinking, and society needs to promote the idea that caregiving tasks are shared equally and that it is not the sole task of women to provide care. Men can do that just as well. If care work is always shifted onto women, this leads to women working part-time because they are still caring for relatives, for example. Then they automatically earn less than men – an endless spiral that we have to get out of.
You are also fighting against the lack of autonomy at work and the hierarchical division of labor. What exactly does that mean and how would you like to organise work in care differently?
I can report from my own experience at work. It’s often the case that it’s not us, but the doctors who decide what needs to be done. It often happens that the doctor intervenes in my profession more than is reasonable. That is a problem, because I have learned the nursing profession and I can and want to determine independently what is good for the patient from a nursing point of view. In German hospitals, however, it is not at all common, or only to a very limited extent, for nurses to have a say in treatments or in questions of care. Too often, the focus is primarily on medical issues that the doctor orders and the nurse is supposed to carry out. If we are to achieve a better appreciation of our profession, it must end with others telling me what to do. Of course we should work together with the doctors, and in many cases this works very well. But we don’t need these hierarchies.
In many hospitals, there is still only a medical director and an administrative director. Where are the nursing staff? We are the largest professional group in the hospital. Many hospitals now also have a nursing directorate with equal rights, but not everywhere yet. That urgently needs to change. To do that, we as nurses have to become even more self-confident. We really have to stand up and fight for this; we have let this happen to us for far too long.
Are such ‘marginal’ topics, which are very important for developing self-confidence in everyday life, topics that you also discuss in the current dispute?
Yes, they are topics. That’s why this alliance exists. We started with the demand for more staff in the hospital, but in the meantime we have gone much, much further. This feminist perspective has become much broader and bigger, but so have many other issues. They’re not always all equally present, but we’re always trying to focus on new issues as well. For example, we have also started to network more closely with the climate movement, because there are many points of contact there as well.
When you’re at a demonstration with 2,000 people, are there also sometimes nurses who carry a self-made sign that says, for example, “Abolition of the hierarchy” or something similar?
Yes, there are. This is becoming increasingly important, especially among younger colleagues. At the moment, the main topic is the need for more staff, but precisely because it’s about better working conditions, other issues always play a role as well. For many colleagues, it is an important question how self-confident and independent they can be in their profession. If I work in a profession where I’m always controlled by others, then at some point I get fed up.
From time to time, there are calls for hospitals to be taken back over by the local authorities, or the demand for ‘re-nationalisation’. Now we are dealing with public hospitals at Vivantes and Charité. Doesn’t the need to strike here, too, because working conditions are bad, make it clear that an even more radical change is needed – perhaps in the direction of a care revolution – in order to fight for a health care system based on solidarity?
In municipal – public hospitals, one already earns better – in Berlin, you are only paid according to the better standards of the TVöD if you work at Vivantes and Charité. So although our working conditions are poor, they are still better than those of our colleagues in other hospitals. I think that remunicipalisation is the right way to go. At the very least, all clinics should be run by non-profit organisations. Private clinics should be abolished, as they are only interested in making a profit – especially the large hospital operators such as Asklepios and Helios. Of course, we can think about a revolution and whether we need a market economy at all. But for now, I’ll start on a small scale, with our struggles.
