Some 130,000 health service workers gathered in the centre of Berlin last Thursday to protest against deteriorating conditions in German hospitals.

The protest was the largest such demonstration in the history of the German Federal Republic. A similar demonstration, but with substantially fewer participants, took place in the 1950s to oppose the health policies of the conservative government led by Konrad Adenauer.

However, the rally provided no program to mobilize health care workers and the broader public against the attacks by the government. On the contrary, it sought to subordinate the workers to the health care employers' organizations. Top union officials who addressed the rally are allied with the Social Democratic Party, part of the coalition government that is carrying out the assault on healthcare and health care workers.

The demonstration was called by an alliance of groups under the slogan "Save the Hospitals." The alliance includes health service trade unions, doctors' associations and other health service groups, as well as employers' organisations and hospital directors. Demonstrators came from all corners of the country, travelling in 800 buses and a number of special trains. Many drove through the night. The organizers had anticipated a turnout of 60,000, and were surprised that more than double that figure joined the protest.

The high level of participation is a clear indication that broad layers of the population are no longer prepared to accept deteriorating conditions in hospitals and repeated cuts in health provisions. Under the former Social Democratic Party-Green Party coalition government and the current grand coalition of conservative parties and the Social Democrats (SPD), the health care system has been undermined by a series of cost-cutting measures. These cuts have been carried through with the assistance of state and local governments.

For the past six years, the German Health Ministry has been headed by Ulla Schmidt. Formerly a leading member of the Maoist Communist League of West Germany (KBW), Schmidt has been a member of the SPD for the last 25 years and is a leading figure in the right-wing SPD faction known as the Seeheim Circle.

The balance sheet of her period in office is catastrophic. Her main aim has been the subordination of public health to "free market" principles and capitalist profit. Hospitals have been subordinated to the so-called "profitability principle" under which they are required to show a profit by carrying out cuts in personnel and wages.

Under the direction of Schmidt, a modern and highly efficient health care system has been systematically undermined.

While the number of patients has risen by approximately 1 million in the past 10 years, over the same period 100,000 hospital jobs have been axed--around half of this figure in the sphere of patient care.

In the German capital city, Berlin, these policies have been carried out with the collaboration of the Left Party. Just 45,000 hospital personnel are charged with caring for 700,000 patients every year. Ten years ago, total personnel in Berlin hospitals stood at 60,000. Since 1990, a total of 23,000 hospital beds have been cut, although the number of patients has increased over the same period by around 13 percent.

Many doctors and nurses on the demonstration described the conditions in Berlin's hospitals as "catastrophic" and "absolutely intolerable." There is a general lack of personnel, and staff are, according to one protester, "hopelessly overburdened, so that at the end of the working day one is simply glad to have finished work without any disasters having taken place."

The immediate issue that prompted the demonstration was the announcement by the federal government of discussions on financial reform of the hospitals. Ulla Schmidt reported that €3 billion would be made available to hospitals. This sum is to be financed by a 0.3 percent increase in the general level of state-regulated health insurance contributions.

According to the organizers of the demonstration, German hospitals need at least twice that sum to cover rising costs. Over a third of hospitals are threatened with insolvency, putting 20,000 jobs at risk.

Even the €3 billion sum announced by Schmidt is not what it seems. One million of this amount is allocated to cover estimated increases in wages for hospital staff, meaning that the real total allocated to the hospitals is more like €2 billion.

Last Wednesday, Schmidt made a point of stressing that no more money could be made available. Under conditions where the future of a number of Germany's 2,100 hospitals is threatened on the basis of the government plan, Schmidt said she expected a "concentration process" to take place, i.e., more closures of clinics and hospitals, with the predictable consequences for jobs. Schmidt's proposals will only accelerate the privatisation of the health care system.

The same government that rapidly made available €9.2 billion of taxpayer money to bail out IKB bank, thereby securing the profits of financial speculators, is refusing to provide the funds for a decent health care system. Moreover, the taxpayers will be forced to foot the bill for the €3 billion in financial assistance to the health care system through increased health insurance contributions.

At the rally in Berlin, the president of the German Council of Cities, Christian Ude (SPD), the mayor of Munich, declared that he was astonished at the amount of taxpayer money being made available to the banks. Ude said that health workers would be satisfied with a fraction of these sums and stressed that one could not subject hospitals to the same profit criteria as businesses. At the heart of the health system, he pointed out, was the well-being of human beings, not just the production of machines.

Ude neglected to mention the fact that the devastating situation in the hospitals was largely created by a ministry led by his own party, and that a large majority of union officials are also members of the SPD.

The leader of the Verdi service workers' union, Frank Bsirske, a member of the Green Party, spoke of the dire conditions in the hospitals. When they could no longer finance electricity and food, other than by resorting to cutbacks in staffing levels, then something was seriously wrong, he declared. He went on to read a letter from a male nurse from the state of North Rhine-Westphalia, which dealt in some detail with the abominable working conditions prevailing in his hospital.

However, Bsirske and his trade union are playing an extremely cynical role in the current dispute. While Verdi banners demanded "More Staff for the Hospitals," and its officials criticized under-funding of the system, the union sees its main task as making hospitals "fit" to compete on the market by collaborating in the imposition of wage cuts and job cuts.

In many public hospitals and nursing facilities, Verdi has worked closely with regional and local administrations to streamline health service in line with the demands of private investors. It was notable that the alliance of unions and employer organisations that called the rally made no demand for financial support to reverse the mass redundancies of recent years.

The anger of health service workers was palpable at the rally. Demonstrators carried hand-painted posters with the slogans "Time to Get Serious," "Every Politician Has a Responsibility" and "Health Cannot be Secured on the Cheap." One poster warned, "No More Cuts: the Next Election is Coming," while another, referring to Health Minister Ulla Schmidt, read, "Send Ulla to the Operating Theatre."

A male nurse who has worked for 20 years at Europe's largest hospital, the Charité in Berlin, told the World Socialist Web Site that dismissals always begin "with the more menial layers of workers ... technical personnel, kitchen and cleaning staff, nurses and, eventually, ward personnel." But, he said, every position is indispensable for the running of the hospital and the health of the patients.

If the cleaning of wards is left to a single worker, he pointed out, hygiene problems are inevitable. He referred to the very difficult situation for nurses. The complex shift system means that nurses are often utterly worn out and "walk around as if they are suffering from jet-lag." The situation is even worse for hospital doctors, who are sometimes on their legs for 24 hours at a stretch--during which time they are expected to carry out operations.

The nurse was infuriated at the proposal by some that the government employ unqualified, long-term unemployed people in the hospital service. Care jobs such as nursing, he said, require several years of training and continuous retraining to remain abreast of the latest medical developments.

When asked about the role of Verdi, he expressed his disdain for the union. Formerly, he had been an active Verdi member, but had left the union some time ago. Currently, only 20 percent of the personnel at Charité are members of the union.