The new Scottish parliament will have unprecedented power to interfere in the running of health boards and trusts, and could jeopardise partnerships between the NHS and local government, some managers fear.
Their concerns have been voiced publicly for the first time in response to a consultation exercise on the new parliament headed by devolution minister Henry McLeish.
Greater Glasgow health board chief executive Chris Spry told HSJ that boards could expect to be kept on a 'very short lead' by the parliament, in contrast to local authorities, which have a line of accountability to local electors.
NHS managers will be under greater pressure to deliver than they have ever been under the Scottish Office, he predicted.
'The Scottish parliament will mean more scrutiny of policy and performance than there has been hitherto.
That's a very significant change. Some people in the NHS will welcome it; others will feel nervous.'
He added that joint decision making between the NHS in Scotland and local government might become more difficult, running the risk of 'destabilising' developing partnerships.
But the impact of the new parliament on the Scottish NHS has not, despite the consultation exercise, sparked much debate within the service.
A spokesman for Stobhill trust said it would not be responding to the consultation exercise because 'we have other things to do'.
Royal Edinburgh Infirmary trust medical director Charles Swainson said it was 'a pity' that most NHS staff were only interested in how the parliament would affect them as citizens, 'rather than how it affects them in the health service'.
'I believe that the health service will be the single biggest target in the new political agenda. Health is a big part of the remit of the Scottish parliament.
'Quite a lot of the powers around education and social services will be held by Westminster. But health is the only one that the parliament will have an easy handle on.'
Dr Swainson said: 'The parliament is a great opportunity. We don't want it to be some sort of Robbie Burns outfit that keeps looking to the past - it should be thoroughly modern. It should look towards Europe.'
John Connaghan, chief executive of Western General Hospitals trust in Edinburgh, said: 'Most health service managers positively welcome the introduction of the Scottish parliament and the direction that it will give us.'
David McNeill, secretary of the Institute of Health Services Management in Scotland, said he had 'no fears' about the parliament's impact: 'It will require managers to deliver the agenda of improving Scotland's health.'