French health workers angry as reforms threaten famous 35-hour working week

Clad in face masks and banging pots and pans, a group of French doctors and nurses formed the latest protest by health workers on Thursday, as they massed in front of a hospital to the north of Paris, with banners stating their demands: “No medals, no tear gas, but beds and money!”

Despite being one of the richest countries in the world, France’s health service lacked staff, masks and ventilators at the start of the coronavirus crisis.

In light of workers’ anger over what they see as an insufficiently funded health service – not to mention the public’s admiration of their valiant response to the Covid-19 epidemic – the French government is treading carefully. On Monday French Prime Minister Édouard Philippe announced a “public consultation” on reforming the health service.

A ‘straitjacket’ for hospitals

Philippe promised to invest “massively” in France’s hospitals – including helping those struggling with debt – while strengthening links between the country’s health and social care systems.

Currently, salaries for French nurses start around €1,500 per month — among the lowest in the OECD, putting France 28^th out of 32 on this measure.

Even before the Covid-19 crisis, many argued that funding for France’s cherished state health service had not risen enough to deal with an ageing population and increasingly expensive treatments. As President Emmanuel Macron’s re-election battle looms in 2022, it seems his government wants to do what Boris Johnson’s Conservatives did ahead of the UK’s 2019 general elections – when they deployed vast new spending plans to neutralise public concern that National Health Service spending had not increased enough for years.

All the signs suggest that pay increases for doctors and nurses will be part of Philippe’s package. However, one line in the prime minister’s address provoked an explosion of chagrin among many health workers, when he said that “working hours” are “not a taboo” and must be re-examined to boost the system’s “agility”. One organisation representing operating theatre staff immediately responded: “Work more to earn more?” – a slogan used by former President Nicolas Sarkozy, admired by many on the French right but a bête noir of the left – “Out of the question”.

A few hours before Philippe’s speech, François Hollande fired a pre-emptive shot across the bow. “You can’t say to staff who have worked without even counting their hours, and who sometimes worked overtime without extra pay, that we’ve now got to get rid of the 35-hour working week,” said Macron’s Socialist predecessor. “Please don’t get rid of what many of us see as a social asset.”

Since its introduction in 2000, France’s 35-hour working week has prompted both envy and French-bashing abroad. It is also controversial at home. Admirers say that it enhances quality of life by ensuring that work is not the be-all and end-all of one’s daily existence, while forming part of a distinctive French social model that resists the homogenising effects of globalisation. Critics say that it is part of an economic system that stifles dynamism and innovation – often pointing to the fact that France’s GDP growth has frequently lagged behind that of its Anglo-Saxon competitors over recent decades.

The 35-hour week is “certainly a social achievement”, said the head of the French Hospital Federation Frédéric Valletoux, “but it’s been a straitjacket for hospitals, where you’ve got people doing different jobs at very different rhythms; we’ve tried to put everyone in the same box, and that caused major organisational problems”.

‘Dangerous’ staffing shortfalls

Many hospital staff work more than seven hours a day. Under the French system, this means they are supposed to get days off to compensate for going above and beyond the 35-hour threshold. Sometimes this system is tricky to manage, noted Éric, an operating theatre nurse in Brittany. While it works smoothly in his current job, in his previous post in the Paris region, “we ended up accumulating a lot of time off, and it was sometimes complicated to take it”.

According to France’s National Union of Nurses, the AP-HP hospital trust – a Paris-based network that forms Europe’s largest hospital group – owed its nurses 1.3 million days off at the end of 2018. Virginie, a night nurse in a surgical unit of the AP-HP, said this situation is linked to the psychological pressure that weighs on nursing staff.

“Next week I’ve got two days off, but I don’t know if someone’s going to replace me; we get a replacement about half the time, so you try to work it out with colleagues,” she said. “Sometimes it’s fine, but at other times it’s hell. Ideally there’s one nurse for every 10 patients, but at night we’re often left with one for every 15. We know that it’s dangerous – that it means it’s harder to be as vigilant. But if something happens, it’s still us who will be held accountable.”

Given the pressures on hospitals, their collective deficits have reached €30 billion. At the same time, the state health service is struggling to attract workers. A 2019 survey by the French Hospital Federation found that 97 percent of medical centres are struggling to recruit nursing staff.

“The 35-hour week is a social asset that was accompanied by the creation of 4,000 hospital jobs. That was undeniably progress, but the way to take things forward is to get more jobs and more hospital beds,” said Thierry Amouroux, a nurse at AP-HP and a spokesperson for the SPNI trade union.

“If we increase the 35-hour limit, that means working more without pay for those overtime hours,” Virginie added. “Unfortunately, that’s already the case. If we stay longer treating a patient or because a colleague is late, we’re told that it’s our fault, that we’re unorganised. We can discuss working times; it shouldn’t be a taboo. But we should discuss the issues surrounding it as well.”

This article was translated from the original in French.