In France, as in other European countries, attempts to rationalise the hospital system have been on the agenda for more than 20 years. While the private-sector term “restructuring” is commonly used, it is possible to show that decision processes and outcomes, particularly in terms of employment, are quite different in hospitals and in the private sector. Trade unions play a minor role in restructuring because they are scarcely involved in the procedures of public health policy and because their influence on decision processes on the ground is marginal. In the event, no union leader rejects the principle of reorganisation, but there is unanimous rejection of accounting requirements. Differences between unions appear not so much at the level of general analysis as with respect to practical positions when tensions arise between defending the hospital and defending its staff. Supply policies are conducted on a national level whereas union action on these matters takes place on a local level. Unions have to choose between refusal or support. In both cases, they have to negotiate acceptable compensations.