In France, the WORKSHOP FOR THE REFOUNDATION OF THE HOSPITAL PUBLIC SERVICE is an initiative that grasps the idea of “collective care” to rebuilt the health system, the public hospital and more broadly, the public health service in the perspective of the commons. It was launched in the context of the COVID19 health crisis, by several collectives gathering through a manifesto published on July 7 and joined by many signatories, both collective and individual. The first workshop took place on October 10, 2020 in Montreuil near Paris. About a hundred people participated in it. Fabienne orsi, one of the initiators presents it to us.

This interview tells the story of this process in a lively way. In particular, Fabienne Orsi highlights all the attention needed to listen to each other and create good conditions for commoning in such a heterogeneous group, composed of health workers, users, researchers and activists from different backgrounds. This is one of the aspects that is too often invisible when we talk about the commons, perhaps because it is necessary to experience it in order to understand it.

Interview with Fabienne Orsi. Fabienne Orsi is a reseracher at IRD (public research institute in France), involved in the struggle for a renew of public health services based in commons. January 2021, Frédéric Sultan.

 

How was this workshop idea born?

Before the pandemic, a mobilization of groups of caregivers was strongly mobilized to denounce the massive attack under public hospital system in France. The question of defending public services was therefore already on the activists’ agenda. The pandemic has only brought to light problems that are already present in the medical, medico-social and hospital environments. It has forced the government to negotiate a national agreement, the Ségur de la santé, which has ultimately break the momentum of the social health movement.

At the time of the containment, people of the collectives met together and questioned how to renew their formats of mobilization. This reflection leads us to pose as a principle that it is necessary to get out of the emergency and give ourselves the possibility of returning to the meaning of the professional activity of care workers.

In certain circumstances, the crisis has exploded the straitjacket of New Public Management. In places where they have been able to temporarily escape this straitjacket, care workers have been able to form collectives and regain a sense of their professional activities. Based on this observation, a small group has the idea of proposing a workshop based on the sharing of expériences and stories of work by care workers, to reinvest the idea of a “care collective”. This group decides to write and launch an appeal that will be widely followed and signed by people from the medical and medico-social world, but also by activists, researchers, …. citizens. The purpose of this workshop will be to rethink what the public hospital service and, more broadly, the public health service is. It will be seen that asking questions about what the healthcare collective is about, what it means to organize collectively, and what about the relationship with the healthcare institutions, brings us closer to the idea of commons and .

How was the workshop organized and held in Montreuil?

Following the call, a working group was set up. This group is composed of members of different health workers collectives, researchers, and activists. A process is being set up. It is necessary to get to talk to each other, to know each other. The care workers are also diverse: by professions, by specialties. Even those who come from the hospital are not always used to talk to each other in the hospital. We are convinced that the first (and after that the others) meeting should take place in person rather than virtually.

For the first workshop, it was difficult to find a place because of the period of COVID19 crisis, but also because of the material conditions we needed. It will be the AERI in Montreuil. Now, we realized that the location was important. Managed autonomously, by a collective that owns it, AERI is a place for popular education activism that can adapt to our formats of work. Because the form of the exchanges will be very important as we will discuss in a circle, horizontally in plenary sessions and parallel workshops. We will have exchanges based on the experiences of the participants rather than on presentations or lectures by experts. This exchange will involve care workers, but also users. It allows us to address the issues of health democracy that are totally absent from the French health care system today. The meeting is a real attempt to set a movement, which is part of the commons, revealed by the circle and the horizontal style of discussion. The report clearly shows the nature of this approach based on the sharing of testimonies.

How is the next workshop being prepared?

The upcoming workshop was also prepared in this way. The date has been fixed during the Montreuil gathering as well as the place: Marseille. It is a question of continuing in the same logic by integrating specificities of the place. The second workshop has been postponed because it is impossible to carry out in the current sanitary conditions. In order to prepare it, the group went back into action. The organizing group is growing, but at the same time, we are getting to know each other better. For example, La Volte, the publisher of Alain Damasio and Sabrina Calvo, decided to join the process. To respect the spirit and horizontality of the workshop, we will give a special place: a “carte blanche” to react to what is said when it seems useful or necessary for them rather than to do a lecture. The idea is to bring out the issue of the place of the imagination in relationship to health and care.

 

What are the perspectives today?

The approach is a long-term one. The central challenge is to keep the link between people while we are in conditions that prevent people from meeting, keeping people wanting and staying together. At the same time, we must also make ourselves known and visible. How to do this ? First of all, there is an ongoing reflection on what could be written. We are thinking to write something to be able to display our approach and position, to make it accessible to the public. And then, we are thinking about how to continue with exchanges through digital tools. We will keep you informed and we are interested in all the ideas and proposals that may come to us. For an example, we’re thinking about possible uses of digital tools with the InterHop collective, which is the bearer of the referral against the contracts that give the use of health data to Microsoft signed by the governement.

And what about the commons ?

Gradually, we’re starting to work on a commons approach with people who don’t care about it, but for whom it becomes an experience in itself. An experiment in self-organization in healthcare, but also in the workshop. It is a question of pooling knowledge, avoiding conferences of experts who come to say what needs to be done. Important to put ourselves on an equal position. But we are not naïve. We can see that there are differences. People who are more comfortable expressing themselves will be at an advantage. Some professonnals are not present. There are few health executives and administrative executives while there is a lot of pressure on them. There is no stretcher-bearer. This raises a lot of questions. It is necessary to create a common language, to find a balance between the academic language and those of the various actors. It’s very fragile and we realize that it requires very fine tuning. This fragility is also very interesting, because it forces us to question ourselves and to hold a way of doing things.

To find out more about the state of the social welfare system and the hospital

To understand the context of this mobilization and to put it into perspective, we recommand to see the two conferences of the Cognitive Capitalism Seminar organized by CEMTI, CES, SOPHIAPOL (only in French):

– Common, health system and health democracy in the face of the challenges of the Covid 19 crisis, a lecture by Philippe Batifoulier, Director of the CEPN, University of Paris 13.

 

The health crisis of Covid-19 is a total and multidimensional crisis which has put back in the foreground the role of the social state to privilege health over budget balance. However, the social aspect is not necessarily carried by the State. The greatest moments of social protection in French history were against the State and based on self-government. A “citizen welfare” is opposed to a “welfare state”. The paper highlights the role of the welfare state in the causes of the health crisis and a possible return of the citizen welfare to get out of the crisis.

– The hospital: a never-ending crisis? a lecture by Fanny Vincent, Lecturer in Political Science at the Jean Monnet University of Saint-Etienne (Triangle laboratory):

 

 

Over-indebted establishments, exhausted professionals, congested corridors, permanent mobilization… and a pandemic! The public hospital is under severe strain. Politicians, technocrats, engineers and consultants, journalists… have been diagnosing for several decades an institution in crisis, poorly organized, too expensive and not efficient enough, mired in red tape and professional corporatism. For their part, health professionals have for years been warning of a chronic lack of resources, a deterioration in the quality of patient care, unequal opportunities for patients to be treated properly, and the desertion of the public hospital by an increasing number of colleagues. To this has been added an unprecedented health crisis, putting politicians, hospital managers, caregivers and patients to the test. In the light of the current situation, this talk looks back at the different interpretations of the “crisis” in public hospitals and their origins. In particular, it shows how the organizational, financial and health crises faced by the hospital were constructed, with disregard for public health.