A-Infos (en) France, OCL CA #360 - Profit at the Expense of Health: A Struggle Within a Private Healthcare Facility (ca, de, fr, it, pt, tr)[machine translation]

The body and health have become lucrative sources of profit for 
operators in the sector, such as the Vivalto group. Like its 
competitors, it is restructuring its services not to meet the real needs 
of the population, but solely to increase its profit margins. At the 
Côte d'Opale clinic, employees have long been at odds with the group's 
management. Recently, management decided to close the maternity ward and 
lay off thirty-five people. We spoke with one of the key figures in this 
struggle.

Can you tell us about the announcement of the layoff plan?

A year ago, we were abruptly informed of the closure of the maternity 
ward during a works council meeting

[1], while being presented with the "strategic directions." "Actually, 
we were expecting it, we were talking about it amongst ourselves, in 
connection with the declining birth rate...

At the time, management assured us that the department wouldn't close; 
on the contrary, they claimed to be starting renovations to develop a 
women's surgery wing while preserving a maternity wing. They even went 
so far as to ask us to be involved in choosing the furniture, the color 
of the new premises, etc. Despite everything, we still held onto a 
certain hope...

How many people did this plan affect?

Management intended to lay off thirty-five people, twenty-four of whom 
were affected by the redundancy plan[2], as well as four salaried 
pediatricians, nurses, a client manager, and hospital service workers... 
Among the group of pediatricians affected by the redundancy plan, one 
chose to retire."

As a union representative, I participate in Vivalto group meetings, and 
in that context, I experienced the closure of the maternity wards in 
Cholet, Béthune, and Saint-Germain-en-Laye. It went very badly, with the 
same brutality. In Cholet, the situation was slightly different; there 
was no surgical department, no pediatrician, and very few births were 
taking place there. But at the Côte d'Opale clinic, the number of births 
was stable, and there were no financial losses, as confirmed by the 
expert report.

As always, it's just a question of profit?

Obviously... Management wasted no time; they immediately began work to 
develop more profitable services. It will be general medicine, so a lot 
of geriatrics, rehabilitation and long-term care, and outpatient services.

Are these investments being made with the group's own funds?

When the Vivalto group became the operator of the Côte d'Opale, it only 
owned the buildings for a few years before selling them to invest 
abroad. In this case, the landlord paid EUR12 million to begin the 
renovations, and Vivalto is paying the remainder. However, since the 
sale of the buildings, the rent has increased fivefold, straining the 
establishment's cash flow.

In which countries does the group invest?

This buy-and-sell strategy has allowed the group to expand and invest in 
Spain, Portugal, Poland, and some Eastern European countries such as the 
Czech Republic and Slovakia. Morocco is also being considered for future 
investments. In some of these countries, the group operates as a public 
service concessionaire. It uses existing infrastructure, provides its 
staff, and reaps the profits without incurring management costs, taxes, 
etc. It's a particular form of subcontracting...

So, since your department closed, the public hospital is taking over the 
patients from the clinic?

Families who used to give birth at the clinic now go to the hospital, 
but it's under the supervision of the Regional Health Agency (ARS) and 
can no longer hire staff. Their maternity ward has to work more, but 
with the same resources; it must be tough for them...

From there, what happened in practice?

Everything happened very quickly. It hit you like a ton of bricks, and 
you don't have time to think. The redundancy plan was implemented, and 
for us, it was a first. Starting in March 2025, we'll have three months 
of meetings, an exhausting marathon... With the help of a lawyer, the 
goal will be to try to leave in the "best possible conditions."

The first layoffs will happen in October, but some of the staff won't be 
affected by the redundancy plan. These were six nurses, a customer 
service representative, and two healthcare assistants whom management 
hoped to redeploy to other departments. Ironically, none of them 
accepted the management's offer. They left with roughly comparable terms 
in terms of seniority, but they did not receive redeployment leave.

How did the other departments react to the announcement of the closure?

Unanimously, it was a terrible reaction. Doctors who had never 
participated in any action before went on strike-a first! The maternity 
ward had always existed, but management was inflexible; even the 
patients didn't understand...
Management's brutality went so far as to force employees to come to work 
and monitor their punctuality, even though the day after the layoff plan 
was announced, the premises had been looted by managers! The labor 
inspectorate intervened and ordered colleagues to stay home.

It's important to understand that management wants to cut staff as much 
as possible because, according to the collective agreement, if the 
workforce falls below 300 employees, we lose the same rights within the 
Works Council, we lose the Health, Safety and Working Conditions 
Committee[3], etc. This is why, in 2020, we launched a strike against 
the outsourcing of hospital service staff, and we won. Previously, we 
hadn't been able to stop management when they decided to outsource the 
kitchen...

Then came the strike...

With the CGT union, we always organize rolling, open-ended strikes. This 
time it lasted three weeks, but we have to admit we didn't get much. The 
starting point was a EUR7,000 raise for everyone, and it was a struggle 
to get it. We quickly realized the director had no real power; he had no 
decision-making authority. We got people moving; the group's HR director 
came down, made promises she obviously didn't keep.

Before the clinic was sold to the Vivalto group, when we went on strike, 
we faced the boss directly. There was a lot of shouting, but the 
decisions were made in his office. Back then, we actually got things 
done. Today, it's much more complicated.

We called off the strike because we couldn't take it anymore... We 
shouldn't have, but when there's no one left to maintain the picket 
line, what can you do?

In a way, the strike was successful because there were many walkouts in 
all departments, which really annoyed management, but the movement 
wasn't as strong as in 2020. Colleagues would come to the picket line 
but wouldn't stay all day. The group of strikers was always the same, 
because there are those who claim to be in solidarity, those who are 
afraid... Currently, losing a day's pay is difficult for some, which is 
why walkouts are successful.

And at one point during the strike, there was an intrusion by politicians...

Can you explain?

I had warned that if politicians showed up on the picket line, I would 
withdraw. They all came, especially the newly elected National Rally MP 
for the district, Antoine Golliot... The first time, the strikers chased 
him away, but a second time a midwife contacted him even though I had 
warned her that if he showed up, I was leaving. He came back, and 
everyone started shaking his hand... From that moment on, I never set 
foot on the picket line again. That was the first time, and the last 
straw... Whether it was him or someone else, it didn't matter; they 
won't do anything for us anyway, and they've proven it!

And now?

Since then, management is more focused than ever on maximizing profits, 
so they have to fill the beds, and there's a lot of outpatient work. You 
can have three patients on the same bed; it's exhausting. And when 
you're having a quiet day, they call you because there's a staff 
shortage in this or that department. Many healthcare workers are longing 
to leave. Three years ago, fourteen employees in the operating room 
resigned, which put management in a difficult position. And we're still 
seeing departures; young people spend two or three years with us, just 
long enough to get their training, and then they disappear-there's a lot 
of turnover... Recently, Vivalto announced they want to charge their 
employees for parking at the clinic! That's already the case at the 
group's main clinic... Needless to say, here, as long as I'm here, 
that's out of the question!

And what about the future?

More and more, you can sense the employees are disillusioned. They 
either go on sick leave or they leave, but the will to fight isn't a 
priority. Despite everything, we often go on strike; management is used 
to it, but this time they were caught off guard. They were hoping to 
quickly close the case, as they had done in their other facilities. 
After that, the bosses are thinking long-term, they have a vision and 
know that the union elections are coming up, and they'd like a CFTC 
majority, but I won't see that happen. I'm keeping my union 
representative position during my redeployment leave, and after that, 
it'll be unemployment...

Boulogne-sur-Mer, March 31, 2026

The Vivalto Group's Position in the Sector
In France, the private healthcare industry is undergoing constant 
restructuring and increasing consolidation. In 2021, there were 468 
private acute care (MCO) clinics nationwide, and the average capacity of 
for-profit rehabilitation (SMR) clinics is currently greater than that 
of the public or non-profit private sectors. These groups employ a total 
of 441,000 people.

Three major groups dominate the sector, each with dedicated real estate 
subsidiaries. Vivalto ranks third behind its two competitors, Elsan and 
Ramsay Santé. The Vivalto Santé Group was founded in 2009 by Daniel 
Caille, formerly head of Société Générale de Santé, and a group of 
Breton doctors. Its revenue currently stands at EUR2.2 billion across 53 
facilities. Vivalto employs 21,000 people.

The sector, in unison, admits to being confident about the future 
because: "it is banking on the aging population and the rise in chronic 
diseases"... The 2004 DRG (Diagnosis Related Group) reform, which 
introduced fee-for-service pricing, only fueled the race for profit and 
fostered competition.

Notes
[1]CSE: The Social and Economic Committee (CSE) is the new employee 
representative body, created by the Macron ordinances. It replaced the 
Works Council (CE), the Staff Representatives (DP), and the Health, 
Safety and Working Conditions Committee (CHSCT).

[2]PSE: A PSE is a plan implemented by the company in the event of 
collective redundancies (more than 10 employees over 30 days). It must 
include: internal or external redeployment measures; training or 
retraining programs; personalized support (via a redeployment unit); 
enhanced severance pay; and a consultation procedure with employee 
representatives. The PSE (Employment Protection Plan) must be validated 
or approved by the Regional and Interdepartmental Directorate for the 
Economy, Employment, Labor and Solidarity.

[3]CSSCT: Health, Safety and Working Conditions Committee. Its 
responsibilities have been carried out since January 1, 2020, by the 
Social and Economic Committee (CSE).

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