BRITONS are living to a riper age—but not without help. As the population greys, more people are needing assistance with washing, dressing and other aspects of their daily care. The King’s Fund, a health think-tank, predicts that over the next 15 years the number requiring such help will rise by 61%. Yet funding for it is shrinking. Between 2010-11 and 2014-15, 15% was sliced off local-authority spending on social care. Pressure is building as the government seeks a further £20 billion ($31 billion) in departmental cuts ahead of a spending review in November.

The squeeze comes as costs are rising. The Local Government Association has calculated that in order to pay all care workers the new £9 minimum wage by 2020, an extra £1 billion will be needed (for context, last year’s entire adult social-care bill was £14 billion). The final straw could be a national shortage of nurses, which is forcing care homes to pay through the nose for agency staff, who charge double the amount of a regular nurse.

Local authorities have responded by tightening eligibility for services, pushing more of the burden onto private purses and unpaid spouses, sons and daughters. Though national eligibility criteria set last year limit how far services can be withdrawn, between 2005 and 2013 the number of over-65s receiving publicly funded social care had already plunged by 30%.

Some care-providers are trying to lower their costs by reorganising their workforce. HC-One, a large nursing-home operator, is training up its carers to reduce the need to hire expensive agency nurses. Staff who previously would have been washing, dressing and feeding are now able to bandage wounds and help manage medicines: things that would normally be done by professional nurses, though they do not need a nursing qualification.

Bigger boosts to productivity will be difficult to find. There are efforts to share more information: Leeds City Council has set up an “Intelligence Hub” to monitor differences in care across the city and identify bottlenecks, for instance. Technology can be used to monitor old folks’ needs, alerting carers only if something goes wrong. But local authorities and providers are limited in how much they can innovate, given strict rules on quality and safety, and most of them lack the cash required to invest in new models of care.

The most obvious remaining savings are not in the social-care sector, but in the National Health Service (NHS). According to Age UK, a charity, last year patients spent 174,000 days waiting in hospital beds for places in residential care homes, even though an NHS hospital bed is more than three times as costly as one in a care home. All eyes are on Manchester, where health and social-care commissioning are to be integrated, in the first large-scale experiment of its kind in England. But any savings are likely to take years to materialise.

Integrating health and social care might boost provision for old folk in another way. In the run-up to May’s election, politicians fell over themselves to promise the popular NHS more money, but were not so generous to the unglamorous world of social care. Rather than scrabbling around for more efficiency savings, the sector might do better by joining up with the NHS and nabbing some of its political clout.