Health and social care organisations are prioritising individual performance over patients, the health watchdog has warned.
Local leaders should be incentivised to work together and judged on how well the system as a whole is meeting the needs of elderly people, according to a report by the Care Quality Commission (CQC).
It calls for a new joint approach to funding, regulation and workforce, to transform "fragmented" health and social care services.
Labour said "a proper funding settlement" was urgently needed "to fix the Tory-made crisis in social care".
The report, published as the NHS prepares to mark its 70th anniversary, follows reviews of 20 local authority areas in England.
Sir David Behan, chief executive of CQC, said there was "urgent necessity for real change".
"A system designed in 1948 can no longer effectively meet the complex needs of increasing numbers of older people in 2018," he said.
"People's conditions have evolved - and that means the way the system works together has got to change too."
Some professionals are "working across organisational boundaries to provide high-quality care", Sir David said.
But he added: "Their efforts were often despite the conditions in place to facilitate joint working, rather than because of them.
"We need incentives that drive local leaders to work together, rather than push them apart."
Leaders are often "judged on their success in terms of individual organisation performance measures" rather than patient outcomes, according to the report.
"Senior leaders report a culture where organisations prioritise their own goals over the whole system's shared responsibility to people using health and social care services," it said.
"We heard about tensions in organisations and across health and social care, influenced by system pressures and accountability against performance measures, such as delayed transfers of care.
"This behaviour hinders joint working."
The report sets out a number of recommendations, including the development of joint workforce plans to make it easier for individuals to move between roles in health and social care.
It also suggests a joint framework to measure how agencies collectively deliver care to elderly patients.
"Only by working across the health and social care system, recognising that health and care services are very often caring for the very same people, can we possibly hope to see the significant and sustainable change that is required," the report said.
Barbara Keeley, Labour's shadow minister for social care, called for better funding for social care.
She said: "Integration of services cannot happen without properly funding social care and the Tories have cut £7 billion from social care budgets, resulting in record numbers of people being stuck in hospital unnecessarily.
"The Tories need to stop kicking social care funding into the long grass with the promise of only a green paper and invest £8 billion extra in social care across a Parliament, with £1 billion up front in the first year, as Labour has pledged."
Caroline Dinenage, care minister, said: "This report confirms what we already know - the provision of NHS services and social care are two sides of the same coin and it is not possible to have a plan for the NHS without having a plan for social care.
"There are good examples of progress in integrating health and care, including through the Better Care Fund and ongoing joint health and social care assessments pilots, but we know we need to do more.
"That's why we will publish a green paper in the autumn on social care around the same time as the Government's long-term plan for the NHS."
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