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Adult social care reform has been long awaited. Over many years, the case for change has been made through commissions, campaigns and inquiries.The diagnosis is familiar: a system under pressure, unable to deliver the support people need, with a workforce and provider market stretched beyond what is sustainable.There is now renewed national focus on reform, which is welcome and necessary. But lasting change requires honesty about the barrier that has held reform back for too long: adult social care still lacks the public understanding, recognition and political saliency it needs.This is not because people don't care. It is because social care remains poorly understood. Too many people are unclear about what it is, who it supports, how it is funded, and how likely it is that they or someone they love will need it.Reform is not only a technical exercise. Funding, workforce, eligibility and service models matter deeply. But it also requires a stronger social contract: a shared understanding of what we expect from care, what we are prepared to contribute and what kind of society we want as more of us live longer. That contract cannot be built in Whitehall alone. It must be built with people in their communities.Around 60% of participants had never taken part in a council decision-making process before, and a similar proportion did not draw on care and support or recognise themselves as carersIn Camden, we have been testing what that looks like. Through Who Cares? our borough-wide conversation about adult social care, more than 1,500 residents took part between September 2025 and March 2026.The work was designed to build understanding, explore what matters if people or those they love need care and develop a shared view of the roles and responsibilities needed for a strong care and support system.Crucially, this was not only a conversation with people already closest to the system. Around 60% of participants had never taken part in a council decision-making process before, and a similar proportion did not draw on care and support or recognise themselves as carers.The future of adult social care cannot remain a conversation solely between professionals, policy-makers and those already drawing on care and support. It must include citizens who may not yet see social care as relevant to them, but whose understanding and support will be essential to securing change.What we found was that while the term ‘adult social care' can feel unfamiliar or technical, the issues it touches are deeply familiar: ageing, disability, illness, family, neighbours, unpaid care, independence and the fear of losing control. When care was framed through real lives rather than systems and thresholds, Camden residents engaged with insight and empathy.There was clear consensus about what matters: dignity, compassion, fairness, choice and control, support to remain at home and connected locally, clearer information for self-funders, and stronger recognition of unpaid carers and paid care workers. These are not new themes for those of us working in social care, but the process gave them a wider local democratic mandate.The ‘Citizens' Expectations' that emerged from the Camden conversations are one practical expression of that mandate. They set out what residents believe should be expected of individuals, communities, the workforce, Camden LBC and central government, recognising that care and support is a collective responsibility.Technology played a role too. Who Cares? tested how digital tools could support participation at scale and pace. But technology alone does not create meaningful engagement. The strength came from combining digital reach with trusted local relationships with voluntary and community organisations, resident groups and community networks,and from making information accessible and inclusive.The lesson from Camden is that national reform will only succeed if it is grounded in public understanding and local conversation. Political will and cross-party support do not emerge from technical reports alone. They are unlocked when citizens recognise social care as something that matters to them personally.Adult social care is experienced in homes, families, neighbourhoods and communities and the debate about its future must be rooted there, too. Local conversations can make care more visible, generate activism, and reveal what people value before decisions are made nationally.If lasting change is to succeed, local places must help shape it, build support for it, and sow the seeds of the social contract on which it will dependJess McGregor is executive director, adults and health, at Camden LBC, and immediate past-president of the Association of Directors of Adult Social ServicesYou can find out more about Who Cares – A Camden Conversation About Adult Social Care at https://who-cares.commonplace.is/

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ADULT SOCIAL CARE

Making care everyone's business

By Jess McGregor | 17 July 2026

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