He served as the second Prime Minister of Barbados between 1976 and 1985. His party, the Barbados Labour Party, had capitalized on the population's desire for a change from Errol Barrow's Democratic Labour Party, which had governed the island since independence in 1966. Adams moved the country back towards the liberalism the BLP had been founded on, a trend in keeping with the popularity of liberal economist Friedrich Hayek in Margaret Thatcher's Britain and Ronald Reagan's United States in the early 1980s. Adams also maintained close relations with the US, and he was the leading proponent in the grouping of Eastern Caribbean states that asked Reagan to intervene in overthrowing the Cuban-backed communist regime of Bernard Coard who had toppled Maurice Bishop, who was later murdered, in Grenada. Barbados was used as a staging point for some of the U.S. forces, and a nominal contingent of the Barbados Defence Force accompanied in the invasion force's wake, not least to allow Reagan to gild the statistics. The Barbadian population was of two minds about Adams' move, generally conceding that Bishop's murder had moved Grenada too far, but being uneasy with Reagan's US heavy-handedness. Nevertheless, Adams' BLP was tipped to win the upcoming elections at the time. Adams died of a heart attack at Ilaro Court, the Prime Minister's official residence, on March 11, 1985. He was the first sitting Prime Minister of Barbados to die in office. He was buried in Bridgetown, Barbados, at the churchyard of the Cathedral Church of Saint Michael and All Angels on Saint Michael's Row. Queen Elizabeth II was among global leaders who sent condolence as was addressed to Sir High Springer, the then Governor-General of Barbados, which read:
″I was very shocked to hear of the sudden death of the prime minister, and Prince Philip and I send our deepest sympathy to the government and people of Barbados. The distinguished service given by Tom Adams to Barbados and to the Commonwealth during nine years as prime minister will always be remembered.″
Adams' deputy Prime Minister, Bernard St. John, succeeded him but the Barbadian electorate turned back to the other political party, voting in Errol Barrow, and his Democratic Labour Party in the subsequent election in 1986. Barrow also died in office in 1987 shortly after his election victory.
