Here to stay
Health workers have entered the arena of class struggle in Germany
By Daniel Behruzi
The nature and composition of class struggle in Germany is changing – and quite visibly. In the past, strikes and trade union demonstrations were dominated by the blue overalls of predominantly male industrial workers. But former union strongholds like the printers have lost many jobs and most of their power. Others, like the metalworkers union IG Metall, are still well organized at least among the older, directly-employed workforces, though less so among the younger more casualised workers. They have not organized a decent strike for two decades – because they do not want to ‘diminish the competitiveness’ of German industry, which they see as a basis for their relatively high standards of pay and conditions. On the other hand, new layers of the working class have entered the scene. Employees in child care and in health care, have come to the fore. Especially in the hospitals, new forms and methods of struggle have been developed and lessons have been learned which can be quite valuable for workers in other sectors and countries.
Twenty years ago, German health workers used to be more or less bystanders, while bus drivers and garbage collectors got the results in public sector wage rounds. This has changed. Hospital employees play an important role now in public sector strikes, including those taking place at the time of writing (end of September 2020). Even more important, several hospital workforces have fought vicious and victorious battles over agreements on safe staffing in recent years. Also, through workplace protests, petitions and demonstrations they have continuously made dramatic understaffing a topic of public debate. This has not solved the problem, but it forced the government and its conservative health minister Jens Spahn to pass several laws in favour of health employees. For example, whenever hospitals raise wages or take on new nurses, these are fully financed by health insurance, which was not the case before.
Charité leading the way
It all started off at Europe’s biggest university hospital, the Charité in Berlin. There, activists from a socialist and Marxist background over years built up a small but determined trade union group. On this basis, in May 2011 they were able to organize a one-week strike for better pay. It was the 300th anniversary of the Charité and therefore they raised the slogan “300 years – 300 Euro”. To demand 300 Euro a month more for all employees was quite ambitious. It was nevertheless achieved, albeit over a longer period.
This strike was a turning point, not just because of its result but because of the way it was conducted. For the first time, hospital workers managed to close down beds and wards during a strike. They told the employer in advance exactly how many nurses in which wards would go on strike, and demanded that the beds be emptied. Before, strikes in hospitals were always limited by the fact that almost nobody could leave the ward without endangering the patients. At the Charité, the workers and their trade union ver.di turned this around: They transferred the responsibility for patients’ security from the employees to the employer. This worked. It was announced up to 200 beds and several wards – including important intensive care units – would have to close during the strike.
Right after this victory, workers began preparing the next step: A strike for a collective bargaining agreement on safe staffing in 2015. After 2011 many employees said: “It's good to get more money, but what we really need is more staff”. In 2013, ver.di activists systematically talked to workers in hundreds of hospitals and found that there was a shortage of 162,000 employees, 70,000 of them in nursing. The trade union regularly organized public protests against this. For example, on 24 June 2015, 162,000 workers came out and stood in front of their hospitals, each worker holding a number from 1 to 162,000 to symbolise the staff shortfall.
To make understaffing an issue in collective bargaining was a new and, inside of ver.di, intensely debated step. The Charité-workers had to overcome much resistance, including their company trying to declare the strike illegal – which failed. The strike lasted two weeks in June 2015. One thousand and two hundred of the 3,000 beds were out of usage, 20 wards were closed completely. More than 450 employees joined ver.di. In the end, the hospital-management gave in and accepted an agreement with nurses-to-patient-ratios and other elements.
New methods
In the years to come, it proved to be very difficult to put these rules effectively into practice and to really achieve a significant easing of working pressure. Nevertheless, the successful struggle in Berlin sparked off a movement in many other hospitals in Germany, where the workforces also demanded relief. Since then, ver.di has signed these kinds of agreements in 18 big hospitals – from Kiel in the North to Jena in the East, from Homburg at the French border to the four university clinics in the southwest region of Baden-Württemberg. In Düsseldorf and Essen in the Ruhr-area, 44 days of strike were necessary to break the resistance of employers in the summer of 2018. A notable feature is that with each agreement its contents got better and more binding on the employers.
During these conflicts, new methods of struggle and participation emerged. Rather than having just a small negotiating team, in many cases, each unit of workers elected delegates who became part of the negotiation process and had a say in all decisions. By this, democratic control and participation from below are ensured before, during, and after the strikes – which is not at all usual in the German trade union tradition. In addition to this, struggles of hospital workers in Germany are increasingly based on new organising methods from the US. Inspired by Jane McAlevey, they use a systematic approach to try to get the majority of workforces to take action in one way or another (see ‘Leaving the Shire’, Samantha O´Brien in Rupture Issue 1). This has been impressively successful.
It's not just strikes. The struggles of German health workers have shown many different possible ways to protest against staff shortages. One is the “ultimatum method”: A team declares that it needs relief. Either the employer takes on new staff or reduces the workload by a set date – or the employees will ‘work-to-rule’ and refuse to do anything beyond their contractual obligations from that day on. For example, they threaten to stop working longer hours or during breaks or to “jump in” when they are off work. Since all care institutions rest on these kinds of voluntary practices, to put this threat into practice would usually mean the breakdown of operational processes. This puts enormous pressure on management – even without a call for a strike. Whenever teams utilized this method, they almost always won concessions. It is a way to “turn solidarity from standing on its head to its feet”, as one activist put it. In everyday life in the hospitals, “solidarity” means to go over one's own limitations, to ignore one's own rights in order not to let down the colleagues. This logic is turned around: In the “ultimatum method” workers promise each other, not to jump in, etc. Solidarity becomes a tool to fight collectively for a better situation. That's what it originally meant.
Reasons for change
All of this confirms the thesis that something is changing in the role of health workers in Germany – although it is so far only a minority of hospitals where such movements take place. What are the reasons for this change? One lies in the effects of marketisation of the German health sector, which was carried through by different governments, conservative and social-democratic alike. For the hospitals, the system of financing through Diagnosis Related Groups (DRG) was introduced, which facilitates price-competition. The major effect was an enormous intensification of work. While nurses and service staff were reduced, the number of “cases” increased continuously.
The initial reaction of most nurses to this has been to ignore one’s own rights, to work longer, not to take breaks, etc. But these individual strategies have their limitations. Increasingly, nurses recognize the need to radically change the framework of their conditions.
The fact that nurses are highly ethically motivated, that they cannot just leave their patients to go on strike, is often discussed as an obstacle for struggles. And it´s true: The “care-ethos” often stops health and other care workers from collectively acting in their own interests. But the cases mentioned show the possibility of turning this around. From “I can't leave my patients, I can't go on strike” it can turn into “I can't care for my patients the way I learned it. I have to fight to change the conditions, so I will be able to do proper care work again”.
A precondition is that employees see a viable way of bringing about this change. Only if the trade union shows determination and high aspirations will health workers join in in bigger numbers. One factor, which facilitates this process in Germany, is the shortage of qualified staff. Nurses can find a job anywhere these days, which makes them more self-confident and less vulnerable to intimidation. While many obstacles still exist and the majority of health workers remain quiet, it is clear that this part of the working class has entered the scene of class struggle. It is here to stay.
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Daniel Behruzi works as a sociologist and journalist in Darmstadt, Germany. He is spokesperson of the ver.di shop stewards at Technical University of Darmstadt and editor of the Marxist magazine “Lernen im Kampf”.