Reflections on Dame Louise Casey’s Review
By Euan McPherson, CEO, Services for Independent Living
A System Under Strain: Dame Louise Casey’s Stark Warning
In recent weeks, Dame Louise Casey has delivered one of the most direct and uncompromising assessments of England’s adult social care system in years. Her government‑commissioned review describes a sector that is “creaking,” confusing, and too often held together by “sticking plasters and glue.” The result is predictable and painful: people’s needs are left unmet, or met far too late.
Casey argues that adult social care has never had its own “Beveridge moment” a national settlement that confronts, honestly and transparently, what care requires, what it costs, and how it should be staffed and funded. Despite decades of debate, reform has been fragmented, reactive, and politically unsupported.
Her message is uncomfortable but essential: if we want a fair, dignified system that meets people’s needs, we must stop looking away from the realities of rising demand, workforce shortages, and chronic underinvestment.
Local Pressures Reflect a National Crisis
While Casey’s review focuses on the national picture, the pressures she describes are felt acutely at the local level.
Local authorities across England are grappling with unprecedented financial strain while still trying to keep vital services afloat. Herefordshire Council, like all councils, is legally required to review and adjust the fees it pays to social care providers each year. These reviews must balance two competing duties:
- Meeting statutory Care Act responsibilities
- Setting a legally balanced budget
The challenge is immense. Councils must account for rising costs across the board: National Living Wage increases, recruitment and retention pressures, fuel and travel costs, utilities, insurance, training, and the wider cost‑of‑living impact on service delivery.
Herefordshire’s situation mirrors the national picture Casey describes: growing need, increasing complexity, and intensifying financial strain.
Fee Uplifts Help — But They Don’t Close the Gap
Even when councils approve fee uplifts, they rarely bridge the widening gap between the true cost of delivering care and what local authorities can afford to pay.
National Living Wage increases drive up wage bills for providers, but central government funding often fails to keep pace. The result is a structural deficit that grows year after year.
Homecare and supported living organisations feel this pressure most acutely. They face rising national wage requirements without the corresponding uplift in local funding. The maths simply doesn’t add up.
Why Local Action Alone Cannot Fix a National Problem
This is the tension at the heart of Casey’s review: local authorities can act responsibly, transparently, and with genuine commitment, but they cannot solve a nationally underfunded system on their own.
Without a national settlement, a national vision, and sustained national investment, local decisions will always be constrained by the limits of local budgets.
Dame Louise Casey’s message is clear: this is not a problem that can be solved through local efficiency or goodwill. It requires national leadership.
A Call for Honesty, Ambition, and Renewal
From my perspective, Casey’s review should be a catalyst for honesty and for renewed ambition.
Local authorities like Herefordshire continue to do everything they can with the resources available. But we must acknowledge the truth: the pressures on social care organisations, the workforce, and the people who rely on support cannot be resolved through local action alone.
If we want a system that reflects the dignity, fairness, and compassion we aspire to as a society, national reform and proper national investment are not optional, they are essential.
As Dame Louise Casey puts it, this is a moment for renewal. The question now is whether we will seize it.
For information about the review visit: The Casey Commission | Independent Commission on Adult Social Care
You can also read this article about a recent visit to gather first hand accounts from our staff for the review Casey Review: Adult Social Care Visit to SIL | Services for Independent Living
