Industrial action which began at a emergency department in a Paris hospital is gradually and quietly spreading across France, even if so far it has largely been ignored by the government. Having started at Saint-Antoine hospital in Paris on March 18th the protest action has spread to twenty-two of the twenty-five emergency units run by the Paris regional health authority the Assistance Publique-Hôpitaux de Paris (AP-HP) and hospitals across France. So far 65 emergency departments have joined the appeal by the inter-emergency ward collective group behind the action and another 61 are considering it, out of a total of 500 public hospital emergency units in the country.
Maintaining the strike this long has already been an achievement, even if many on strike are then formally 'requisitioned' or required to work by the hospital authorities to ensure they can maintain a proper service. But despite the length of the industrial action it has still not attracted much attention. In the more than two months since it began, the health minister Agnès Buzyn has effectively managed to ignore the strike. “It's not linked to workplace conditions,” she has declared, despite plenty of evidence to the contrary.
Enlargement : Illustration 1
To help broaden the movement further, some 200 nurses and auxiliary nurse from across France met on Saturday May 25th at the Bourse du Travail union centre in Paris for a general assembly. The meeting began with staff from different hospitals telling their individual stories which all painted a picture of a service that is on the verge of breaking down.
The action at Purpan hospital in Toulouse in south-west France, for example, started after the death of a patient from a heart attack in what one nurse described as “shameful circumstances”; the person died while on a stretcher in a corridor, unattended by the only nurse there, who was overwhelmed by the number of patients. “Management played it down, for them it was just a mishap. They treat us like children, ridicule us. We demonstrated in front of the Regional Health Authority and we were tear-gassed. But we will continue to fight for quality, decency and dignity,” said the nurse.
Nurses from Aix-en-Provence in the south of France then described how a building designed for 90 patients a day is now handling “up to 200”. A nurse said: “The cubicles which are small and have no windows were designed for one patient but we are making space for two with the resulting smells and lack of privacy. Our equipment is not maintained.” She continued: “We recently got new stretchers but with no Velcro. We call them the toboggans: all day we're picking up patients who have slipped.” A nurse from Angers in central western France said that just a few days earlier they had still been “playing Tetris [editor's note, a tile-matching puzzle video game] with the stretchers. We were piling up patients in the corridors of the admin offices, with no one watching over them.”
All the nurses spoke about the appalling turnover of staff and the precarious status of those who stayed. “I've been in the emergency department for three years,” said Joséphine (not her real name), a nurse in Toulouse. “I've seen 80% of the [accident and emergency] service leave, I'm already an old hand. Yet I've only just been taken on as an intern.” For her this means the end of constant short-term contracts, and after a year as an intern she will obtain a formal position in the public health service.
Just about all these emergency services have experienced the limited impact of isolated industrial action, action which, at best, has led to a few extra staff being provided – staff who are simply taken from other hospital services. In Lille in northern France the hospital emergency services have faced no fewer than three strike movements in recent years. “The first was by doctors who were fobbed off with endless working committees that achieved nothing; two others were very difficult with the management going so far as to make a formal criminal complaint against the trade unionists. We can't get out of this if we remain on our own,” said nurse Vincent Porteous. Back in 2018 there was a four-month strike at hospitals in the eastern city of Lyon, but again they led nowhere. “They though we were too worn down but we started up again,” said Anna, another nurse. “This collective [movement] is important. We have to keep on giving evidence, evidence and more evidence. And highlight the responsibility of the Ministry. As long as we don't frighten them...”
The three trade unions who support the emergency department nurses' movement – SUD, CGT and FO – were represented at the Paris meeting but only a few officials were present. The collective of paramedics behind the movement is happy to accept union support and advice but wants to remain a grassroots organisation which makes its own decisions. They have called for a national demonstration on Wednesday June 6th, and have set up a national committee so that they can officially hold negotiations with the Ministry of Health.
At the Paris meeting the movement adopted a motion outlining the three demands they have been making from the start. The first is the “reopening of beds” throughout the hospitals. For while all the staff point to the growing numbers of patients going to emergency departments, increases in the order of 5% to 10% a year, it is after the accident and emergency stage that the blockages occur. All public hospitals in France are engaged in an unprecedented exercise of reducing the number of beds with the aim of achieving what critics see as an attempt to achieve an optimal but absurd occupancy rate, one that is incompatible with the unpredictable nature of health demands. Nurses from Saint-Nazaire in west France say that they have a “98% bed occupancy rate … in a hospital built seven years ago in a public-private partnership which is already obsolete”.
The second demand relates to staffing numbers: the collective wants extra staff hired to meet the needs in each hospital service. They base their figures on those recommended by the accident and emergency health trade union SAMU-Urgences de France. These figures show that in the AP-HP Paris health region alone an extra 700 staff are needed. The final demand is for a pay increase of 300 euros a month.
Will these demands spread to all hospital services, not just emergency departments? The health unions want them to and they have called for national action, but so far the call has gained little traction.
However, the current action among casualty nurses may soon spread to emergency room doctors. Indeed in several hospital emergency wards, such as in Saint-Nazaire, doctors have already joined the movement. “On some evenings we have 140 patients in casualty with four doctors, that really worries me,” says Florian Vivrel, a doctor who works between the emergency departments in Saint-Nazaire and nearby Nantes. “In the view of our head of service, who's been battling with management for months, striking is the only way to save our service.”
On Tuesday May 28th the main emergency department trade union, SAMU-Urgences de France, issued a statement directed at the health minister which spoke of a “breaking point never [before] reached” by the emergency departments and of the “bursting point of personnel who can no longer accept working in circumstances which are now incompatible with the quality and safety of treatment”. It called for a five-minute stoppage at work on the same day to highlight their concerns.
“It's symbolic,” said the union president François Braun. “But working with the words 'on strike' on your hospital gown is also just as symbolic. It is without doubt ridiculous in relation to the scale of the problems. The other option is to send all non-urgent patients home. That's a major risk. But something is going on: we've received more reports of burn-out since the start of 2019 than during the whole of 2018. I hope the minister hears, she has to listen.”
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- The French version of this article can be found here.
English version by Michael Streeter