Before devolution, it was only on very rare occasions that a health service manager might be called to account for their actions before MPs sitting on Westminster committees. The trip down to London was usually undertaken only in extreme circumstances - the seat of power being little concerned with dayto-day machinations of bodies such as individual NHS trusts.
With the new governments in Scotland, Wales and Northern Ireland, however, scrutiny has become the name of the game.
Senior managers can expect not only to be held to account through the auditing process, but also in person, to elected representatives of national bodies keen to make their mark and show they are making a difference.
During the last session of the Scottish Parliament, for example, NHS managers were called to appear in front of a number of committees. To name but a few, Greater Glasgow health board chief executive Chris Spry and North Glasgow University Hospitals trust boss Maggie Boyle were quizzed by the petitions committee to ensure their processes for consulting on the on-going acute services review were robust.Over at the audit committee, members of the Scottish Parliament almost despaired of ever getting to the bottom to the shenanigans in Tayside University Hospitals trust, which were eventually blamed on poor governance and communication problems.And That is not even taking into account the health and community care committee, which has recently grilled Scottish National Blood Transfusion Service bosses, among others.
So are the health services in the devolved countries prepared for the more intensive goldfish bowl?
English managers might do well to learn from their experience in the event that devolution comes to what some say is its natural conclusion in the form of regional assemblies.
Donald McNeill, Scottish secretary of the Institute of Healthcare Management, believes it is an issue that cannot be ignored.
That is why the institute is joining Unison in a one-day seminar that aims to prepare delegates for such appearances.
The seminar, which takes place in November, follows various half-day courses organised by the Scottish Executive Strategic Change Unit.
Mr McNeill says: 'There is a recognition that managers, especially senior ones, are going to come under increased scrutiny by the Scottish Parliament and its various committees. Some of them have found it a bruising experience and they haven't felt prepared. The tone can be quite adversarial. The Scottish Executive has run half-day courses, but theoretical support doesn't really equip you for the real thing.You can only improve at the real thing by repetition, doing it over again.'
Mr McNeill has not yet been called to give evidence.Nor has Hilary Robertson, Scottish director of the NHS Confederation. But she has spoken to managers who have found the experience, if not enjoyable, certainly useful. 'They felt involved with the process and were interested to hear what the elected members had to say, ' she explains.
But what of the senior health service figures who have taken part? Tayside University Hospitals trust chair Peter Bates was a witness to the audit committee's evidence-taking sessions on the deficit run up by Tayside University hospitals.His position was the enviable one of newcomer - nobody could point the finger at him because he had only just taken up the post, long after the extent of the problems had been uncovered.
Nonetheless, he believes his background in social services prepared him well for the ordeal.
'In local government, every six weeks there was a public meeting where senior officers would be examined, often vigorously, by publicly elected representatives.
But It is a very new culture in the health service and one which, in my view, should be warmly welcomed as long as it develops in a constructive way.'
He believes the Scottish Parliament has made a significant difference to public bodies in Scotland. And he does not believe it should be considered a threat by good managers.
'Top managers in the health service recognise that what we need is the very opposite of secrecy. But if there are others who think they can go on as some have been doing, then they need to wake up and realise that the culture is changing.'
Public affair organisations and lobbyists have already smelled the coffee and are offering training in committee appearances. Robbie MacDuff, managing director of Strategy in Scotland, is well-placed to offer such training, having appeared before the standards committee to give evidence on how lobbying should be governed. 'I rather enjoyed it but maybe That is just the type of person I am, ' he told HSJ. 'We haven't trained any NHS managers yet, but given the emphasis that the parliament rightly places on health, then that could change.'
Training for his clients involves homework on the committee, its political composition, its previous decisions and recommendations and on the individual interests of MSPs - what questions they have asked on related subjects, for example.
They will also test prepared statements for their veracity and ability to stand up to close questioning. Role-playing will sometimes be benign, sometimes aggressive and sometimes (mirroring un-named MSPs) completely off the wall: 'It is not about manufacturing a new personality, It is about improving the professionalism and competence of the voice, ' he says.
Some NHS bodies have already offered a similar service to staff, not, it has to be said, to universal approval. Tayside's Mr Bates, for example, was astonished to receive flak for preparing staff for their committee appearances with role-playing exercises. 'I couldn't believe it when there was criticism from some quarters.
Preparing staff for such things is part of being a good employer.'
Strategy in Scotland:
0131 558 8677