There is concern over care of the elderly

The King's Fund report said the problem was set to worsen over the next 20 years unless urgent action was taken.

Its year-long investigation found poor access to care and support and wrangles over who should pay - and warns problems are not confined to London.

The Department of Health said it was currently drawing up proposals for reform of adult social care.

If we got it right more older people could lead independent lives and exercise the choice and control we all desire Niall Dickson, King's Fund

The report also identifies problems with untrained staff being put in charge of elderly people's care, and a lack of choice about what kind of services they receive.

The elderly are often in a vulnerable position, and are unsure about what is available, so do not challenge what they are offered, the report added.

People 'missing out'

The King's Fund said the complexities of the care system were at the root of the problems they identified.

Its report made 30 recommendations for action to improve care services immediately, and in the future.

Julia Unwin, who chaired the inquiry, said: "Care and support services for older people in London are in a sorry state.

"Many older people simply aren't getting what they need and steps to improve the situation are being hampered on several fronts.

"At the root of this is a poorly developed care market that is failing older people and their carers."

She added: "The government is increasingly looking to empower older people through the use of direct payments and individual budgets, but this will not be successful unless there are sufficient services of the right kind that people want to buy."

Ms Unwin said the government must urgently review its decision not to increase funding for adult social care and older people in the short term.

She added: "With services for older people currently high on the political agenda, the time is now right to take concerted action."

Green Paper

King's Fund chief executive Niall Dickson said: "This substantial inquiry has relevance nationally - many of these findings are not peculiar to London.

"This is a story of a market that is failing and needs to be improved in many ways.

"It is the story of a neglected area of our national life with muddled policy and what looks like inadequate resources.

"If we got it right more older people could lead independent lives and exercise the choice and control we all desire."

The Kings Fund has commissioned Sir Derek Wanless to carry out a review of social care needs for the elderly to evaluate the likely costs over the next twenty years.

A Department of Health spokesperson said: "This report is a valuable contribution to the debate about future models of care for older people. It is particularly helpful, as it is time to begin a new debate about what it will take to deliver dignity for life.

"We are currently considering the responses from the consultation on the Green Paper on adult social care and will shortly be deciding on the shape of the follow up to the Green paper.

"We will look at the concerns raised in this report as part of that process, alongside a host of other decisions over the months to come."

Shadow health minister Simon Burns said: "This report is a damning indictment of the problems with long term care in London, which are also reflected elsewhere in the country."

Sandra Gidley, Liberal Democrat spokeswoman for older people, said: "A measure of a civilised society is how it treats its older people. This report demonstrates that our society is failing."