This week's interview with Channing Wheeler, commercial director general at the Department of Health, highlights the complexity of the relationship between the NHS and the independent sector.
On one hand, large swathes of NHS staff - not least medics - view private sector involvement with deep suspicion, a view shared with many members of the public. Indeed, there have been occasions where local people have opposed development of an additional but private sector led health facility, putting them in the improbable position of campaigning against more services.
On the other, independent providers are still wary of the DH. The CBI warned last month that the cancellation of independent sector treatment centres may dissuade companies from future bids. The framework for external support for commissioning is struggling to get off the runway, hampered by primary care trusts' difficulty in determining what help they need. And some primary providers are finding engagement with strategic health authorities a struggle.
Mr Wheeler is ambitious - within five years he wants independent providers to be part of the natural weave of NHS services, driven by patient choice.
But ministers have to win hearts and minds to deliver such a momentous change. They need to convince sceptical providers they are serious about the prospects for the independent sector delivering care, not just using the threat of competition to drive improvements. And they need to convince staff and the public that independent provision will improve services, not undermine them. They have a long way to go.