Interview with Olivier Terrien, General Secretary CGT CHU (Centre Hospitalier Universitaire, University Hospital Center) de Nantes, France.
The CGT (Confederation Generale du Travail) at the CHU de Nantes [University Hospital Center of Nantes] is the center’s leading trade union, and it regularly strengthens its position with each election, increasing both its number of votes and its percentage of the vote.
Communiste Hebdo 1. What do you think of the situation in general right now, after the long struggles against the Macron pension reform that was adopted using all the tools available in the Constitution, Article 40, Article 49-3, despite strong opposition from the population, with inflation soaring and aggravating the difficulties of wage earners, young people, and pensioners, the ministerial reshuffle, and the appointment of a new Minister of Health?
Olivier Terrien: The CGT of the CHU strongly mobilized against the pension reform, not only during the interunion days, but also gave effective support for workers of companies on intermittent strikes, with a presence on the picket lines of companies in struggle and during company blockades. The position of the inter-union coalition, which called for days of demonstrations and struggles based on the parliamentary schedule, raises serious questions. Intermittent strikes are not “a fantasy”, as CFDT secretary Maryse Léon put it, but a means of reversing the balance of power in favor of the workers, those who are fighting. It’s a way of getting the government and capital to bend. Past struggles have shown us that we must hit them in the wallet, that we must attack their profits.
Inflation has hit many households hard, and for hospital staff it’s dramatic: France is 28th out of 32 countries in the ranking of hospital nurses’ pay. In July, the pay rate was raised by 1.5%, from 4.85€ to 4.9227€, not even 5€!!!! The government has announced “a bonus for certain hospital civil servants”. We’re not fighting for bonuses, we’re fighting for pay raises, to make up for the freezing of salary increases for the past 10 years. With the rising cost of energy, gasoline, and foodstuffs, many people can no longer make ends meet, creating anxiety on top of increasingly tough working conditions.
The appointment of a new health minister won’t change a thing; the political options are the same. A. Rousseau has already proved his worth during his time at ARS in the Île de France region: he favored bed closures, service restructuring and the development of the private sector. He will apply Macron’s policy, which accelerates the destruction of public hospitals.
It is only through struggle that we will have a public health service that meets the scientific and technical advances of the 21st century, a public health service financed 100% by social security and 100% free of charge.
Communiste Hebdo 2. What’s your analysis of the situation of public hospitals today, a situation resulting from a health policy that’s advanced with a very precise goal that you’ve already mentioned in several of your interventions in the media and during the struggles to defend the public hospital?
Olivier Terrien: The French are very attached to the public hospital system and social security; to attack them head-on was doomed to failure, so all governments, whether right-wing or socialist, are forced to move forward “in disguise”. But from the very first reforms, the goal was set: to break up the public hospital system and privatize the healthcare system, and each reform allowed them to go even further.
Under Sarkozy, we had the “2007 Hospital Plan, with T2A”, the “HPST Law, creation of the ARS, establishment of the “Communautés hospitalières de territoire”[Teritorial Communty Hospitals], and under Hollande : the “Loi Modernisation de Notre Système de Santé, (Marisol Touraine)”[the Law of the Moderniqtion of Our Health System], with the obligation to create Groupements Hospitaliers de Territoire (GHT) [Territorial Hospital Groups] and to involve “private establishments”, with Macron: the “Loi Ma Santé 2022 Law of My Health 2022], Buzyn,”, then the “Ségur de la santé”[Health Cure].
These various laws do everything in their power to break up the public hospital service and deliver it into the hands of finance capital. Public hospital services are not the only ones under attack; all public services are affected. All governments apply the same strategy: to divert part of the activities of public services to the private sector, which gradually absorbs them.
Macron is pursuing the same policy as previous governments, he wants to finish what his predecessors started: the break-up of public hospitals to hand them over to the private sector. They have long been preparing the population for this privatization of public hospitals.
By allowing private practitioners to work in [public] hospitals, and by allowing them to charge higher fees, they have not only introduced inequality of treatment among patients – those who can pay are treated more quickly – but they have also undermined the principle of free care: if you pay in the public sector, why not go private?
The public-private Groupement coopératif sanitaire (GCS)[Cooperative Health Group] brings the private sector into the public hospital. At the CHU in Nantes, Saint Brieuc, Maubeuge, etc., medical imaging services (scanner, radio, MRI) have been pooled, and appointments are booked overnight in the private sector, whereas in the public hospital you must wait a month or more. The GSC has the right to recruit private-sector staff. It is not the role of public hospitals to privatize their missions and staff.
GHTs [Territorial Hospital Groups] create competition between public hospitals and private clinics. Services designated as “duplicate” will be closed. GHTs are accelerating the closure of services and beds and eliminating thousands of public-sector jobs. Their aim is to reduce healthcare costs and undermine the status of hospital staff. The result is an unprecedented deterioration in the supply and quality of public healthcare.
The State’s pullback from hospital investments is forcing them to take out toxic loans. For example, Nantes University Hospital has taken out 3 so-called “toxic” loans, one of which is indexed to the Swiss franc, forcing it to make provisions of 43 million euros to cover uncontrollable interest rates. At the same time, the ARS is facilitating the reorganization of the for-profit private sector by granting it authorization to operate without the constraints of public service, and by subsidizing its restructuring operations.
With expenditure well below rising costs, there is no funding to keep up. The 2023 budget is down due to inflation, and will once again lead to cost-cutting plans, bed closures and job cuts. To balance the budget, we’ll need an additional 3 billion euros.
The ARS and hospital directors are betting on ambulatory care to make savings, and this too is unfair competition with the private sector. In the private sector, patients are sorted and only those who make a profit are kept; the others are discharged, which frees up beds, and it’s the public hospital that looks after the patients of private clinics.
The development of ambulatory care has multiplied the elimination of traditional hospital beds, and therefore a reduction in the number of downstream beds for emergencies. This has led to a crisis in the emergency care sector, as there are no longer enough beds to accommodate them.
The Ministry, the ARS and the management of public hospitals are practicing a policy of refusing care. The government itself has created a shortage of staff to justify bed closures, lengthening waiting times, and those who can afford it are going to private clinics, while the rest are forgoing care.
Hospital restructuring systematically results in bed closures. When the ARS decides to restructure a hospital, it forces bed reductions and undersizes the new buildings, resulting in a reduction in activity. This is the case at the Nord Franche Comté hospital, where 200 beds are missing; at the Grand Paris Nord hospital in Saint Ouen, which is to bring together the Bichat (Paris) and Beaujon (Clichy) hospitals, with 200 conventional hospital beds eliminated and 1,200 fewer maternity places; at the Nantes University Hospital, reconstruction at the Île de Nantes with the purpose to bring together the various transferred services, where the new construction is undersized with no possibility of enlargement.
Entire departments are being handed over to the private sector, as in the case of the Nantes University Hospital’s hand surgery department, which has been transferred in its entirety to the Elsan group’s “Clinique de la main” [Hand Clinic], to which the university hospital pays into its budget for emergencies.
For several decades, care workers have been fighting for new jobs, new beds and higher pay. Staff shortages are jeopardizing the public hospital system, and while the crisis is most acute in the emergency department, it spares no department. At the Segur summit, 15,000 new staff were promised for public hospitals, but we’re still waiting for them!
There’s no one left on the job market, nursing staff are exhausted, sick leave and absenteeism are skyrocketing, and caregivers can’t take it anymore. There are more resignations than new hires.
Nothing has been done to anticipate retirements; on the contrary, it’s a way of closing departments. At the Erdre et Loire hospital in Ancenis, the director has announced the closure of the maternity unit in November, using the retirement of an obstetrician-gynecologist as a pretext. The closure of the maternity unit, the closure of night-time emergency services, the reduction in the range of services on offer – the Ancenis hospital is [now] threatened with closure.
There are no training plans, no financial resources to match needs. Between now and 2030, we need to create 110,000 nursing and midwifery posts, 110,000 nursing auxiliary posts and 20,000 doctors. We’re a long way off!
Deteriorating working conditions, the institutionalization of mistreatment, and poor remuneration are driving care workers out of the profession, and 200,000 nurses of working age have left the profession.
Understaffing is leading to a deterioration in the quality of the working life. Work intensification and the race to make a profit are leading to the dehumanization of care. In the absence of staff, caregivers must speed up their work and spend less time with patients, which is detrimental to the time they spend with them. It can happen that a caregiver must deal with 24 patients during the day and over 40 at night. It’s impossible to take care of patients under these conditions. Increased workloads and a faster pace of work with fewer staff mean that we must come back to work on days off, combine afternoon and morning shifts, and fill in on short notice. These conditions have both a physical and psychological impact on the health (6) of our staff.
Poverty in the psychiatric sector, with patients left unsupervised and untreated, leads to both mental and social consequences. Child psychiatry is the hardest hit, with staff shortages, treatment delays of several months, and the closure of beds and centers.
Inadequate salaries in public hospitals mean that many caregivers are unable to resist offers from private clinics to “triple their salary by working half as many nights a month”.
Successive governments have given the public hospital enough power to break it up. But that’s without counting on the struggle and dedication of the hospital staff who hold the hospital together. Users have a decisive role to play in this fight against the government’s policy of destruction.
Communistes hebdo 3. You have clearly shown how, for several years now, everything that has been done to hand the public hospital over to the private sector. How can we organize the fight? What are the solutions?
Olivier Terrien: Public hospitals don’t belong to hospital workers; they belong to people who use the hospital. It’s with them that we’ll get the government to back down and implement a public hospital service that meets society’s needs. When we talk about healthcare, we’re talking about the whole of society, and we need to be reactive to every attack, mobilizing not only healthcare workers but also users. We need to go much further than demonstrations.
Only by struggle will we be able to stop the destruction of public hospitals and obtain the financial resources to develop them. Healthcare must be a public service, with 100% social security funding. If the public hospital is to fulfill its missions, we need to increase its financial resources, raise the salaries of all staff, improve working conditions through massive recruitment of permanent staff, develop training, and make the hospital attractive again by giving care workers real career development prospects.
The means are there: we must stop giving gifts to employers by abolishing social security contributions. Social Security must be financed by social contributions deducted equally (50%) from salaries and the wealth produced by employees (employer’s share), and the State must compensate Social Security for any loss of revenue caused by an executive decision. And it’s only by working together that we can achieve this. All these battles are necessary, and they show just how essential it is to change society and rid it of capitalist exploitation, to make workers’ health a priority, not capitalist profits.
. Regional Health Agency
. Activity-based pricing
. Cf Hebdo n° 399, April 2015, Les socialistes accélèrent la casse du système de santé public
. Cf Hebdo n° 599, février 2019, A. Buzyn veut en finir avec le service public hospitalier
. France’s leading private healthcare operator.
(6) Reminder: WHO definition of health: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
-Translation by Mark Burton