Health secretary Frank Dobson openly admitted to something of which he has long been accused, during questions at one of the annual conferences earlier this month. Did he regard himself as secretary of state for health or for the NHS, he was asked. Hesitating for barely a moment - his civil servant minders must have held their breath - he walked nonchalantly into the trap: 'For the NHS,' he replied.

After the best part of two decades' expansion and official approbation for the developing 'mixed economy' in healthcare, the private sector has come up sharp against the broad and very cold shoulder of the present secretary of state, determined to exclude it from his plans to make services modern and dependable. What is more, the private sector appears rather short of friends in high places.

For example, David Hinchliffe, chair of the Commons health select committee - currently contemplating proposals for regulating private healthcare - notoriously revealed his feelings to HSJ earlier this year: 'I hate the bastards.' And prime minister Tony Blair, however keen to demonstrate that New Labour is simpatico to other parts of the private sector, evidently draws the line at health.

It is unsurprising, therefore, that the government's determination to exclude the private sector from regulation by the Commission for Health Improvement has survived an earlier Conservative attempt in the Lords to ensure CHI's remit covered independent hospitals. On the Health Bill's return to the Lords last week, the Opposition backed off from confrontation and let the Commons' reversal of their amendment go unchallenged (see news, page 2).

Clearly, Mr Dobson has little truck with anyone who chooses to be treated in a private hospital: they will not be afforded the peace of mind which comes from knowing that the full might of the state is behind ensuring their care is the best possible.

If the private sector could assure its patients it was subject to exactly the same standards as the new NHS, it could deploy a powerful marketing weapon. It is now pinning hopes on the consultation document, which appears to sanction the private sector regulator contracting with CHI to appoint inspectors (see news focus, pages 12-13). As the Health Bill will allow the prison and defence medical services to buy in CHI's help, it will be one small step for a future government to bring independent hospitals under CHI's wing.

That, of course, presupposes that by then the new NHS reforms have not proved so successful that the private healthcare has withered into insignificance.