After yet more violent assaults [2] on doctors and nurses in China, the issue of hospital workers’ safety is once again in the headlines. The authorities have promised to beef-up security, while media commentators in China have predictably highlighted the need to tackle the high cost of healthcare and the corruption inherent in the system.

However, no one seems to be asking what the trade union at China’s hospitals is doing to protect its members. This is probably because people have such low expectations of the union that it would not even occur to them to ask. But just as factory workers are beginning to ask “where is the union? [3]” perhaps China’s healthcare workers need to start thinking about what the union could and should be doing for them.

After all, healthcare workers’ unions in Europe, North America and Australia have played a vital role for just about a hundred years now, fighting for decent pay and working conditions in hospitals, care homes and community health centres. The problem in China of course is that hospital trade unions are not actually healthcare workers’ unions. At public hospitals, the union’s primary function [4] is to act as a bridge between the Communist Party and the staff and help hospital management “create a fair, democratic and harmonious working environment that gives full play to the staffs’ potential.” In privately-run hospitals, if there is a union at all, it will most likely be controlled by management, much in the same way that enterprise trade unions in factories are.

This is obviously not the best foundation for worker activism but amid the Party speak that dominates the website of the Tongji University Hospital Trade Union [5], for example, there is a requirement for the union to wholeheartedly serve the staff and look after their livelihood (关心职工的生活, 全心全意为职工服务). You can see similar declarations by other hospital trade unions around China, so there is clearly scope for hospital workers to legitimately ask how is their trade union matching up to these requirements.

One of the most fundamental rights of workers is the right to a safe working environment, and to be protected from violent assault whilst carrying out their work duties. If hospital employees are getting assaulted, the trade union has to demand action from management to ensure all staff members are adequately protected. This means adopting a zero tolerance approach to violence and providing staff with the training and back-up they need to deal with violent patients and family members.

Just as important, however, is for the trade union to demand that all hospital employees; doctors, nurses, administrators, support staff and security guards get a decent salary and reasonable working conditions. Nearly all of the problems in China’s hospitals at present come down to the simple fact that members of staff are under-paid, over-worked and under-appreciated.

And the situation is getting worse because the low salaries and poor working conditions mean that hospitals cannot recruit and retain the well-qualified and experienced staff they need to provide a decent service. This puts even more pressure on existing staff and only exacerbates the tension between hospital workers and patients.

If there is one place in China that really needs a strong union presence, it has to be its hospitals.