Title

Being president of the Association of Directors of Adult Social Services (ADASS) at such a critical moment feels like an emotional rollercoaster.There is the exhilaration of the Prime Minister's commitment to adult social care reform and of Baroness Louise Casey's determination to move beyond sticking plaster solutions. But as well as exhilaration, rollercoasters can also bring disorientation.Adult social care is fundamentally disorientating. If it was not, it would not need reform. It is amazing in such circumstances how skilled and committed people make good adult social care happen every day, despite the ludicrous distorting forces around them. They have to, really. There's too much at stake.How much better it would be if everything moved in the same direction: better lives for people who need care, better lives for unpaid carers, better reward for our workforce and better value for the public purse from the right outcomes being achieved at the right time in the right place.However, public service reform can feel disorientating too. There is so much going on at once and a key job of government is to convey a coherent totality, to make it all make sense.It is also true that designing change is one thing and helping it land well is another.Still, after years of demanding adult social care reform, it is invidious to complain when it arrives – even if there is rather a lot of it. In the first speech I made when I picked up the presidency of ADASS in April, I said that we in adult social care could not just wait for Baroness Casey to save us. I said we had to get out of the ‘crouch position' and having spoken to a fair few people since, I think it struck a chord.The starting point of adult social care is promoting wellbeing and thereby preventing, reducing or delaying the loss of choice, control and dignity. Uncoupling assessment from that purpose hardwires both unhappiness and avoidable cost.That means humility, avoiding polarisation and being thoughtful about trade-offs. Not every problem has a simple solution. Sometimes progress depends on managing the relationship between two things that both matter.Take assessment. A locally labyrinthine system that people neither understand nor trust is indefensible. Bureaucratic gatekeeping also pulls colleagues away from the therapeutic, connective and preventative work that brought many of us into social care.However, a simple national prescription carries risks too. ‘Points mean prizes' might offer apparent certainty, yet it assumes assessment is where social care begins. It is not.The starting point of adult social care is promoting wellbeing and thereby preventing, reducing or delaying the loss of choice, control and dignity. Uncoupling assessment from that purpose hardwires both unhappiness and avoidable cost.So yes, we need an approach that is nationally understood, transparent and straightforward to navigate. But it must enable councils to think locally and act personally long before anybody asks about eligibility.Another area of current concern is the mooted separation of older people from adults of working age, the idea that there could be two separate systems. Or, even more complicated, that there might be different approaches for different conditions, for dementia, motor neurone disease and so on. This is fairly easy to caricature and dismiss. It is complicated, and medicalised, it denies individuality, it visibly builds-in both ageism and ableism.But, at the other pole, and this is something I think has caught the Casey Commission's attention, is the risk of mindlessly defending the current system for all adults that purports to be needs-led and for everybody, but in which both ageism and ableism are potentially buried. It is an opaque, generic soup that is complacently assumed to be palatable for everybody. The answer may well remain a single system for all adults, but adult social care reform will need to build a whole that is greater than, not less than, the sum of its parts.Meaningful reform will require more than another restructure. It means starting with the lived experience of people who need care, unpaid carers and our frontline workforce. It means working through trade-offs without posturing or polarisation, with national government holding up its end of the bargain.There is enormous commitment and ability across our communities and organisations. It is time to roll up our sleeves. As the Prime Minister said a few weeks back, we can do this.Phil Holmes is president of ADASS and executive director of adults, wellbeing and culture for the City of Doncaster Council

Title

NCASC

Adult social care: Rolling up our sleeves on reform

By Phil Holmes | 11 November 2026

SUBSCRIBE TO CONTINUE READING