This time we are going to do it! 

By Richard Humphries and Bernie Enright

For decades, successive governments have promised reform of adult social care. Reviews have been commissioned, reports have been written and solutions have been proposed. Yet meaningful, lasting change has remained out of reach… until now.  

What we’ve got at the moment is a sense of hope that real change is possible. There is a really strong sense that we have a new Prime Minister that is prepared to stick with it and see it through. But there are such a lot of issues to be tackled. It’s not going to be achieved overnight. We’ve had several false dawns, and that’s why now we have to hope that Baroness Casey’s review will take that bigger, wider approach and really ask some searching questions about what kind of social care system do we want for ourselves, our families, the people that we care about and the communities that we live in. 

Those of us who have spent our careers in social care know there are no simple solutions. Reform will require tough choices, political courage and sustained commitment. But there is something many people in the sector have not felt for a long time: hope. 

And perhaps, in the words of the Prime Minister, “this time we’re going to do it…” 

Beyond the funding debate 

One of the reasons social care reform has repeatedly stalled is that the national conversation becomes trapped in debates about money before we have agreed what social care is actually for. 

Questions about funding matter. They always will. But they are not the most important questions we need to answer. Before deciding how social care should be funded, we need to decide what kind of social care system we want. 

We’re hoping that Baroness Casey will look at the big debate about where we are. In the 21st century, we are in dramatically different circumstances to when the welfare state was set up, when social care was not really part of the picture at all. We’ve never had the fundamental debate about what is it, who’s it for, what does it consist of and what’s the best way of helping us all have good lives; the best lives we can as we get older and we live with long-term health problems, disabilities, mental health issues or whatever it may be.  

The public has a strong understanding of the NHS. People know what it is, what it does and why it matters. Social care does not enjoy the same level of understanding. Many people do not think about social care until they or somebody close to them needs it. Others assume it is primarily about care homes or helping people leave hospital. The reality is far broader than that.  

Adult social care supports people of all ages to live their lives with independence, dignity and purpose. It helps people with disabilities, mental health needs, dementia, learning disabilities and long-term health conditions remain connected to their communities and achieve the outcomes that matter to them. 

The opportunity presented by Baroness Casey’s review is not simply to recommend reforms, but to start a national conversation about what social care should be for in the decades ahead. And the time for that debate is now. 

Supporting people to live ‘gloriously ordinary lives’ 

One of the most powerful themes emerging from recent discussions about reform is the need to reframe how we talk about social care. Too often the focus falls on hospitals, delayed discharges and crisis services. While these are important issues, they are not the full story. At its heart, social care is about helping people live what Social Care Future describes as “gloriously ordinary lives”. 

That means supporting people to stay connected to their families, maintain friendships, participate in their communities, find employment, live in suitable housing and pursue the things that matter most to them. Across the country, councils and those working in adult social care are doing this every day. 

Many people receiving support never enter residential care. Significant numbers of adults supported by social care are under the age of 65 and living independently in their own homes. Technology, occupational therapy, housing adaptations, reablement services and support for unpaid carers all help people maintain their independence and quality of life. Yet these successes often receive far less attention than the challenges. 

Prevention is not a luxury 

If there is one lesson local government has learned over the past decade, it is that prevention works. The challenge is that prevention requires investment in a system already operating under immense pressure. 

In Greater Manchester, integrated neighbourhood teams have brought together social workers, nurses, GPs and other professionals to support people closer to home and earlier in their journeys. Investment in reablement and early intervention demonstrated that helping people maintain or regain their independence produces better outcomes for individuals while reducing costs across the wider system. This is not simply an aspiration. It is evidence-based practice – we know it works and that it saves money.  

Programmes focused on helping people recover, rebuild confidence and regain daily living skills have shown that many people require little or no ongoing statutory support afterwards. Those are better outcomes for individuals and a more sustainable outcome for public services. 

As Archbishop Desmond Tutu famously said: “We need to stop pulling people out of the river and go upstream to find out why they are falling in.” 

The future of social care cannot be built entirely around responding to crises. It must focus on helping people stay well, connected and independent for as long as possible. 

A workforce fit for the future 

Social care staff support people with increasingly complex needs, often at the intersection of health and care. The responsibilities expected of frontline care workers today are significantly greater than they were even a decade ago. Yet too often pay, training and professional recognition have failed to keep pace. 

The Prime Minister’s commitment to a Fair Pay Agreement, stronger career pathways and greater investment in workforce development has therefore been widely welcomed. 

Parity of esteem between social care and the NHS is long overdue. 

A stronger workforce is not simply about recruitment and retention. It is about ensuring people receive the high-quality support they deserve. It is about creating rewarding careers and professional opportunities. And it is about recognising the skill, compassion and expertise required to support people with dignity in some of the most challenging periods of their lives. 

At the same time, reform must preserve choice, flexibility and control. The goal is not greater bureaucracy. The goal is to improve people’s lives. 

Building a social contract for care

Another challenge facing social care reform is that England has never had a social contract for care, a mutual understanding of the roles of citizens, communities and the State about the respective roles each should play in offering care and support – and paying for it. These questions are often avoided because they are politically difficult. Yet they sit at the heart of every debate about social care.  

Across the country, deliberative democracy projects, citizens’ assemblies and community conversations have shown that when people are given the space to discuss social care properly, they engage thoughtfully and constructively. The national conversation being led by Baroness Casey will be important. But it should also be accompanied by local conversations in communities up and down the country. 

Directors of Adult Social Services are uniquely placed to help facilitate those discussions because they understand both the realities of the system and the aspirations of the people who draw on care and support. 

Challenges and optimism for Burnham 

Being Prime Minister is almost certainly the toughest job in the country. The demands on his time and energy will be absolutely relentless. His biggest challenge is to sustain his focus on adult social care and not get distracted by bigger things that are happening on the geopolitical stage, we need him to keep his stamina and sustain his commitments.  

That’s why ADASS should be as supportive as we possibly can be and help to keep the pressure up for the momentum for change.  

The need for cross-party consensus should not be a reason for the lack of action in the short term. The government has a big majority. It is possible to get on and do things. It’s time for some really calm, reasoned, level-headed sense. We’ve all got to amplify that because whoever is in government, they’ve got to face the same issues. 

In Greater Manchester, the Prime Minister had a really strong focus on people and place rather than political divide, and that’s what we are hoping he will deliver now. There is real optimism at the moment and he is trying to give the nation hope. He has always advocated strongly for social care, always giving it parity of esteem with the NHS. Last week he shared with us all his very heartfelt story about – his father who is living with dementia and their experiences as a family.  

As Dr Anna Severwright of Social Care Future has said: “We all want to live in a place we call home, with the people and things we love, in communities where we look out for one another, doing the things that matter to us.” 

The challenges are significant, but so is the opportunity – if it doesn’t happen now it never will. This time we are going to do it!  

Bernie Enright was the Executive Director of Adult Social Care at Manchester City Council for eight years until Spring 2026. Richard Humphries is a former DASS, the Trustee representing Associates and has written books on adult social care. They are both ADASS Associates.