Six out of eight unions sign agreement for state-owned hospitals

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On 14 March 2000, six trade unions, (CFDT, CFE-CGC, CFTC, CGT-FO, UNSA and SNCH) signed a memorandum of understanding with the Ministry for Employment and Solidarity, which provides for extra funding of FRF 10 billion for France's state-owned hospitals over three years, of which FRF 3.8 billion in 2000. Two unions, CGT and SUD-CRC, refused to sign the agreement, which they described as "inadequate".

On 28 January 2000, for the first time in 20 years, all the trade unions organising in the state-owned hospital sector unions issued a call for a national strike (FR0001136F). The Ministry for Employment and Solidarity convened negotiations on 2 February, and the unions reasserted their resolve by organising a rally on 3 February. Five rounds of negotiations followed, finally resulting in the drafting of a tentative memorandum of understanding on the night of 29 February-1 March.

The memorandum is divided into four sections. The first section, to be implemented immediately, is geared to solving staffing problems relating to: the replacement of those on sick leave or in training (measures worth FRF 2 billion); improving working conditions (FRF 1.4 billion); boosting resources for emergency units (FRF 0.3 billion); and reducing the problem of violence against staff (FRF 0.1 billion). The remaining three sections, which are more "qualitative", deal with forward-looking management of employment, training and the recognition of professional experience. Major emphasis is placed on the development of social dialogue at all levels.

Of the FRF 3.8 billion in additional funding earmarked for 2000, the government will provide FRF 2.6 billion and the National Salaried Employee Health Insurance Fund (Caisse nationale d'assurance maladie des travailleurs salariés, CNAMTS) FRF 1.2 billion. The implementation of the memorandum is expected to create 12,000 new jobs.

Trade union responses and agreement for doctors

The trade unions had until 13 March to indicate whether they would sign up to the agreement. However, the Minister was committed to implementing it, "regardless of how many unions came on board".

In the opinion of the CGT union confederation, this memorandum of understanding represents both "renewed vitality for state-owned hospitals and tangible solutions to their problems". However, this position does not mean that employees will necessarily follow its lead since, the union stated, there is always a major disparity between the government's proposals and the needs of hospital staff. CFDT called the agreement "interesting" with "significant, well distributed" funding. CGT-FO stated that significant progress had been made between the initial funding proposal and the most recent version. However, the union remained non-committal, saying that the funding offered, taken as a whole, was "significant" but that it could not say that it would sign up. UNSA stated that it was "moving towards signing" due to "significant advances" that had been made, but was demanding details regarding the use of the funding for replacement staff. CFE-CGC was delighted at the the "quality of the negotiations" but disappointed that the status of managerial and managerial staff will not be reviewed until the first half of 2001. CFTC stated that it was "satisfied". The only union to give clearly negative feedback on the memorandum was SUD-CRC, which stated that the funding was "inadequate". The money available for replacement staff would "create only 10 or so new positions per hospital, which falls far short of real needs".""

In early March, the Ministry signed a separate memorandum of understanding with hospital doctors. In an attempt to address the major disparity between the wages of hospital and private-sector doctors, this specific memorandum, in particular, proposed an annual bonus – referred to as the "public service commitment bonus" (prime d'engagement de service public) - of FRF 25,000 in 2000, rising to FRF 36,000 in 2002, to be paid to those state-owned hospital doctors with no private sector activities. The total cost of these measures stands at FRF 1.8 billion over three years, of which FRF 955 million in 2000.

Six unions sign deal

On 14 March, CFDT, CGT-FO, UNSA, CFTC, CFE-CGC and SNCH (a hospital management staff union) announced that they were signing the overall hospitals sector memorandum. However, this move did not indicate unreserved union approval of hospital policy. CGT-FO stated that "essentially, FO is not altering its appraisal of the situation and condemns restrictions based on purely accounting-driven considerations rather than those meeting the healthcare requirements of the population." UNSA said that it will "follow the implementation of the agreement in the field very carefully to make sure that it affords hospital staff a genuine improvement in their working conditions, which is essential if patients are to be provided with quality care".

Unsurprisingly, SUD-CRC did not sign the memorandum, stating that "union demands have not been met and between FRF 10 billion and FRF 15 billion are required for 2000 alone, as well as 40,000 new jobs."

CGT, which is the best-supported union in the state-owned hospital sector after recent workplace elections, organised a referendum on whether it should sign the memorandum. Of those who voted, 45.5% were in favour and 53.5% were against. In the opinion of CGT, "signing [the agreement] does not really change the scope of union demands. Three sections (modernisation, other issues and social dialogue) of the memorandum were approved by voters in the referendum. However, the first section dealing with jobs was rejected by healthcare staff. The decision by the Ministry not to review the issue of the replacement of absent staff constitutes a stalemate. It serves no purpose to run away from the issue of staff shortages."

At the beginning of March, the Minister stated that the extra funding "would not be doled out blindly but rather according to the particular situation of individual hospitals". Therefore, negotiations on the actual implementation of the agreement will take place at the individual hospital level.


This agreement has been reached against the backdrop of unexpected growth-generated extra revenue from taxes (known as the "kitty", or cagnotte, in France). This extra revenue enables the government to cover the vast majority of the extra spending on hospitals. The government has set out its spending plans for the next three years. Beyond that period, the Minister has made a commitment to maintaining funding, but has as yet to give specific details.

However, the CNAMTS is still responsible for funding FRF 1.2 billion of the extra spending in 2000. Technically speaking, increased contribution revenue - also linked to growth - should enable the fund to honour its funding commitment without any problem. The additional funding to be borne by the CNAMTS is put into perspective by comparing it with the total of FRF 260 billion earmarked for the state-owned hospital sector under the social security funding law passed by parliament in autumn 1999. Therefore, technically, the CNAMTS has the necessary funds available. However, there has been criticism from many quarters over a system whereby a package of spending measures is passed by parliament in the autumn, only, under social pressure, to be increased by a ministerial decision and imposed on the CNAMTS, which in theory is an independent agency.

The MEDEF employers' confederation, which has been demanding – within the framework of the CNAMTS strategic plan - savings in the state-owned hospital sector of FRF 32 billion over five years (FR9907197F), reacted to the additional funding of FRF 10 billion over three years for the state-owned hospital sector by saying that: "our next strategic plan will have to factor in the extra FRF 10 billion to our current FRF 32 billion savings shopping list, giving total required savings of FRF 42 billion. These savings will only be possible if the state-owned hospital sector is restructured." MEDEF is surprised that, "although we, at the CNAMTS, are seeing some hospital services transferred to the family medicine sector, the government is now opting to increase resources for state-owned hospitals."

The decisions made in favour of the state-owned hospital sector have been taken against the backdrop of two different realities. First, in terms of health policy, a debate is going on as to the role of the hospital in the healthcare system. All those concerned contend that there must be coordination between state-owned hospitals and so-called "family medicine." (médecine de ville). The reality is that two separate budgets exist, one managed by the Ministry (hospitals), and the other by the CNAMTS (family medicine). Second, negotiations on the implementation of reduced working time are taking place throughout the civil service (FR0003151F). The hospital sector is apparently being dealt with differently from the rest of the civil service. (Pierre Volovitch, IRES)

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