It is obviously in the interest of patients for the system to provide co-ordinated treatment – with support at home taking account of what's happened in hospital. So obvious, in fact, that integration of England's medical and social care reliably emerges as a big NHS reform proposal every few years. But as Ed Miliband and his health spokesman, Andy Burnham, made the case afresh on Monday, there are two particularly big reasons to hope that this old new idea will finally come to pass.

The first is the ageing of society. As the demographic bulge of the baby boom edges into retirement, we will witness an acceleration of an established upward trend in myriad diseases – from brittle bones to diabetes – that require support and monitoring in the community, as well as the occasional trip to the infirmary for more dramatic interventions. Easing the back-and-forth between the two halves of that is an end in itself, but – assuming that the monitoring is done adequately – more joined-up care should also help with the second big reason to hope integration wins this time, namely the bleakest financial outlook in health service history.

The raging NHS arguments of recent decades have all been about rival means proposed to increase efficiency – centrally set targets, market mechanisms and so on. There is less argument about what the end of greater efficiency would involve – the transfer of activity from costly-to-run infirmaries to (hopefully) cheaper community care. It is no coincidence that the most serious previous push for integration was launched by Barbara Castle in 1976, amid what was – until recently – the sharpest retrenchment since the second world war. Her efforts ultimately ran aground as cash-strapped councils and powerful hospitals both manoeuvred to reassert separate authority over their budgets.

The first question for Messrs Burnham and Miliband is how they will steer away from the same rocks. Amid the confusion and the brain drain produced by the coalition's Health and Social Care Act, they naturally stressed that they could forge the system's missing link without another top-down overhaul, but they might discover that some adjustment of the way that money flows through the system is the only way to break the near-total grip on resources that the big hospitals have maintained through all the reforms.

They also need to be clear-headed. No reform will see off deep underlying pressures on the budget; when the best that can be hoped for is that scarce funds will be stretched a little further, talk of "saving billions" hits the wrong note. Mr Burnham, however, has shown a sustained interest in the neglected field of social care since his days in government. He deserves credit for continuing to plug away.