Max du Pre, the American industrialist influenced by Robert Greenleaf’s idea of the “servant leader”, said that servant leadership is, among other things, about bearing not inflicting pain.

As the storm clouds gather this may be the best advice we can give ourselves. The media is full of the public sector squeeze and there is little doubt that we are in for a very tough time.

Any suggestion of managers being exempted from the budget reductions will go down badly with frontline staff

Managers and those who aspire to leadership must bear as much of the forthcoming pain as they can. The route map is simple to describe and difficult to follow. Four approaches will send the right signal and leave the people of the NHS with the clear impression that those who manage, and aspire to lead, are bearing the pain.

First it will be vital to protect patients and carers as much as possible. It is unlikely they will be unscathed. Some gains of the last few years may well be lost.

If it is necessary to restrict services then it will be important to explain why in clear and simple terms. There must be the strongest focus on productivity, on doing the same or more for less. Inefficiency that leads to unnecessary cuts will be very difficult to justify.

Second, frontline staff must not feel they are the only ones bearing the pain, even though any rigorous approach to productivity must affect them. Given that almost 70 per cent of costs relate to staff and the vast majority of staff are frontline there is no way to avoid the impact.

However, it is vital what is done feels fair. Staff in wards and community teams must feel that staff in support functions are at least equally affected and that productive approaches apply to all parts of the organisation. The rumour mill will be working at full tilt and it will be important to rebut rumours honestly.

Third, management itself must be seen to bear its share of pain. Any suggestion of managers being exempted from the budget reductions will go down badly with frontline staff and the public. There will be fresh need for the role and contribution of managers to be explained and justified.

If it becomes clear that a significant part of managers’ time is spent on feeding the beast rather than on delivery then this is a good time for a grown up conversation about targets and performance management.

It is of course possible that cuts in management will be seen as an easy option but that will make it harder to make needed changes.

Fourth, this will be a good time for keeping a close eye on rewards and in particular on any remnants of a bonus culture that rewards senior managers excessively. It will be provocative if rewards appear to be earned by successful implementation of cuts in frontline services.

This is a time for restraint and, where appropriate, for self denial.

Many groups have done well in recent years, including GPs, consultants and senior managers. Substantial rewards for managers are easier to justify in times of plenty. In times of famine they will be unwise and inflammatory.