Alberta Budget 2025: Healthcare Union Stakeholder Brief

Executive Summary

Budget 2025 presents healthcare unions with the dual challenge of navigating health system restructuring into four agencies while positioning for collective bargaining. Health entity compensation rises to $10,453M (1.9% increase) while physician compensation is $6,990M. The $4B contingency explicitly references collective bargaining, providing fiscal room for negotiations. However, the creation of Acute Care Alberta, Primary Care Alberta, Assisted Living Alberta, and Recovery Alberta raises fundamental questions about bargaining unit structures, employer relationships, and worker job security. Assisted Living Alberta's placement under Seniors, Community and Social Services rather than Health changes the governance relationship for continuing care workers.

Top 5 Relevant Budget Measures

1. Health entity compensation at $10,453M -- up $197M or 1.9% from 2024-25 forecast of $10,256M, growing to $10,790M by 2027-28. This is the total compensation envelope for non-physician health workers across all health entities.

2. $4B contingency with collective bargaining reference -- the budget explicitly states the contingency addresses compensation expense for collective bargaining currently underway. This represents the primary fiscal room for negotiated increases beyond base budgets.

Four-agency health restructuring -- Acute Care Alberta (hospitals, urgent care, EMS, cancer care), Primary Care Alberta ($322M budget), Assisted Living Alberta ($3.8B under Seniors), and Recovery Alberta (addiction services under Mental Health and Addiction). Each agency becomes a distinct organizational entity with governance implications for unions.

Assisted Living Alberta operating at $3.8B -- transferred from Health to Seniors, Community and Social Services, with a 5% increase from population growth. This agency manages continuing care, home care, and community care, employing a large workforce of care aides, LPNs, and support staff.

Personal Support Worker wage enhancements -- $40M per year for three years under the Aging with Dignity federal agreement to enhance wages for PSWs in continuing care. This funding supports improved outcomes in a growing segment of the care workforce.

Risks

Organizational restructuring uncertainty. The creation of four agencies from the existing AHS structure raises questions about which entity is the employer of record, how bargaining units are configured, and whether labour relations transfer provisions will protect existing collective agreements. Transitions of this magnitude historically create confusion, disruption, and worker anxiety.

Compensation growth below inflation. Health entity compensation growth of 1.9% is below the 2.6% CPI inflation forecast. In real terms, this represents a decrease in per-worker compensation unless workforce growth absorbs the full increase. Workers will argue they are falling behind the cost of living.

Assisted Living Alberta governance. Placing continuing care under Seniors, Community and Social Services rather than Health raises questions about whether continuing care workers will be subject to the same collective agreements, compensation frameworks, and working conditions as acute care workers.

Workload intensity. Despite $24B in total health spending, the budget acknowledges surging population creates fiscal challenges for the health system, including growth in the elderly population, increasing patient complexity, and rising wages. Healthcare workers on the front line experience these pressures as increased workload, mandatory overtime, and burnout.

EMS under acute care. EMS operating at $764M and EMS capital (vehicles) at $60M support emergency medical services. The placement of EMS under Acute Care Alberta may change governance and management structures affecting paramedic unions.

Opportunities

Collective bargaining fiscal room. The $4B contingency explicitly referencing bargaining provides documented evidence that the government has fiscal capacity for negotiated increases. This strengthens the union's position at the bargaining table by countering government claims of inability to pay.

Workforce shortage leverage. Alberta's health system faces well-documented recruitment and retention challenges. The budget acknowledges this through nurse practitioner funding ($20M), physician recruitment, and rural health initiatives. Healthcare unions can leverage workforce shortages to negotiate improved compensation, working conditions, and recruitment incentives.

Continuing care wage enhancements. The $40M per year PSW wage enhancement under the Aging with Dignity agreement provides a model for broader wage improvements in continuing care. Unions representing continuing care workers can build on this federal-provincial commitment.

Mental health workforce expansion. Recovery Communities at $147M and Specialized Mental Health and Addiction Facilities at $210M require staffing. Union members in mental health and addiction services see growing demand and can negotiate for adequate staffing ratios and compensation.

Primary Care Alberta positions. The establishment of Primary Care Alberta with a $322M budget creates new positions for nurses, nurse practitioners, and allied health professionals in community-based care. This represents potential membership growth for healthcare unions.

Likely Government Intent

The government is using health system restructuring to centralize control over health spending while the $4B contingency provides flexibility for collective bargaining outcomes. The four-agency model is designed to create clear accountability lines and potentially introduce competition or benchmarking between agencies. The government wants to manage collective bargaining outcomes within the contingency while signaling willingness to negotiate. The PSW wage enhancement demonstrates awareness that the lowest-paid health workers need targeted support, but the government is cautious about broad compensation increases that compound over years.

Immediate Questions to Ask Ministries

1. Health: How will bargaining unit structures be configured under the four-agency model, and what labour relations transfer provisions will protect existing collective agreements?

2. Treasury Board and Finance: What is the government's timeline for collective bargaining with health sector unions, and how is the $4B contingency allocated across bargaining groups?

3. Seniors, Community and Social Services: How will Assisted Living Alberta workers' employment terms, collective agreements, and working conditions be maintained during the transition?

4. Health: What staffing ratio standards or guidelines will Acute Care Alberta and Primary Care Alberta establish, and how will these affect workload for existing staff?

5. Mental Health and Addiction: What workforce plans are in place for Recovery Communities and specialized mental health facilities, and what are the staffing requirements for new facilities?

48-Hour Action Checklist

• Analyze health entity compensation data and map against membership wage expectations
• Assess four-agency restructuring implications for all affected bargaining units
• Review $4B contingency language and prepare bargaining position on fiscal capacity
• Brief union executive, steward network, and affected locals on health system changes
• Prepare member communication explaining budget health measures and union response
• Consult with labour relations counsel on implications of organizational restructuring for collective agreements
• Identify priority workforce issues for immediate government engagement

30-Day Monitoring Checklist

• Develop comprehensive bargaining strategy incorporating budget fiscal analysis
• Engage Health ministry, agency transition teams, and employer representatives on union recognition
• Monitor agency establishment timelines and governance structure announcements
• Track Assisted Living Alberta transition process for impact on continuing care workers
• Assess staffing data across health facilities for workload and vacancy evidence
• Engage media on healthcare workforce investment narrative
• Coordinate with other health sector unions on common advocacy and bargaining positions

Suggested Message Frames

Frame 1 -- Frontline Investment: Alberta's healthcare workers are on the front line of a growing, aging province with increasingly complex health needs. Budget 2025 must translate $24B in health spending into the staffing levels, working conditions, and compensation that attract and retain the nurses, aides, technicians, and support staff patients depend on.

Frame 2 -- Fair Bargaining: The $4B contingency acknowledges that collective bargaining is underway and that fiscal resources exist for fair outcomes. Healthcare workers have delivered through pandemic, population surge, and system restructuring. They expect negotiations that reflect inflation, workload intensity, and the recruitment crisis facing Alberta's health system.

Frame 3 -- Restructuring with Respect: The transition to four health agencies must be managed with respect for healthcare workers. That means labour relations transfer provisions that protect collective agreements, transparent communication about organizational changes, and assurance that restructuring will improve -- not worsen -- the working conditions that affect patient care.

Opposition Narratives to Anticipate

"Health worker compensation is already high." Counter with data on workload intensity, overtime, burnout rates, and vacancy levels. Compensation must be compared to the demands of the work and competing jurisdictions, not headline numbers alone.

"Restructuring will improve efficiency and benefit workers." Acknowledge the potential for improvement while insisting on concrete protections for workers during transitions. History shows that restructuring without worker protections leads to confusion, demoralization, and departures.

"The contingency is for emergencies, not compensation." Point to the budget's own language explicitly referencing collective bargaining as a purpose of the contingency. The government has committed publicly that this fiscal room exists.

"Union demands will increase the deficit." Respond that investing in healthcare workers reduces costly overtime, agency staffing, and recruitment. Underpaying health workers creates larger costs through turnover, vacancies, and reduced care quality.

Data Points to Monitor

• Health entity compensation data and per-worker growth rates
• Agency establishment timelines and bargaining unit configuration decisions
• Contingency allocation announcements, particularly education and health sector amounts
• Staffing vacancy rates, overtime data, and worker turnover statistics
• Assisted Living Alberta transition milestones and continuing care workforce impacts
• EMS response time data and paramedic staffing levels
• PSW wage enhancement implementation and coverage
• Other public sector collective agreement outcomes for precedent analysis
• Inflation data and cost of living indicators for bargaining evidence
• Health system wait time and access data as indicators of workforce adequacy