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Older people's services are being rationed because of chronic underfunding, which puts lives at risk and jeopardises plans to reform the NHS, according to a major report from 21 older people's organisations published last week.

The Social Policy Ageing and Information Network (Spain) report - written and led by Help the Aged, Centre for Policy on Ageing, Arthritis Care, Age Concern and the Alzheimer's Society - says the underfunding leads to "back-ups and bottlenecks" in the health care system, threatening the realisation of the NHS Plan and the objectives of the National Service Framework for Older People.

It also creates waiting lists for those in greatest need, little or no support for others, and a lack of preventive services. Low cost ceilings on individual care packages for older people result in inadequate levels of care, poor quality, inflexible services and restricted choice, while charities, families and even service users themselves subsidise the shortfalls in local authority funding, it adds.

The report claims social care for older people is rationed in four ways. First, by denying help to those with moderate care needs or with live-in carers. Secondly, those with high care needs have to wait for help. Thirdly, by limiting the amount of money allocated to each person, thus denying people choice. And fourthly, by the strict limits on the amount and quality of care users receive.

The report claims 700,000 older patients have experienced problems and delays in leaving hospital in the last year.

"While substantial new investment is promised for the NHS, there has been no comparable review of social care funding," the report states.

The Spain report calls for an increase in the government's social care spending, as well as a comprehensive "whole system" review of social care funding for older people in parallel with, and in support of, its new investment in the NHS.

The group also wants to see the creation of a National Care Commission to monitor trends in demand and spending, to ensure transparency, and to plan for future needs.

"Many of the valuable targets to improve the quality of older people's care in the NHS Plan and the NSF will fall by the wayside if this imbalance in funding between health and social care is not addressed urgently," said Centre for Policy on Ageing director Dr Gillian Daley.

- The Underfunding of Social Care and its Consequences for Older People from www.helptheaged.org.uk