It should be no surprise that it was people working at the weekend who took to Twitter and other social media after the government's call for the NHS to be a seven day service.

Doctors, nurses and other NHS staff felt outraged that their hard work was being ignored and undervalued, and the hashtag #ImInWorkJeremy was trending throughout the weekend. They are the ones delivering emergency services 24 hours a day, seven days a week.

Every Saturday, Sunday and bank holiday, thousands are at work delivering care to patients. This includes consultants and junior doctors, nurses, ambulance staff, porters, therapists, caterers, cleaners and many more, including managers. They work in hospitals, mental health organisations and ambulance services as well as in the community. GPs work for on-call services and 111 call takers have their busiest times.

The system cares constantly and is always ready to leap into greater action when crises occur. This is the NHS at the weekend.

I understand the sensitivities of NHS staff who feel that this hard work has been disregarded. However, I wonder if we can also interpret Jeremy Hunt's call for a seven day NHS as a call for greater provision where patients want or need this, with NHS resources used to provide a greater range of more consistent and convenient high quality services every day of the week.

So perhaps the question should not be 'do we already deliver 24 hour services?’, but ‘are the services we run and the way we run them sufficient for the needs of an ageing, sicker population?’, and ‘will the current system continue to meet the aspirations of a younger population used to 24/7 access to what they want through technology?’

Let's have realistic public conversations about what is essential and what is desirable, what is achievable and what is affordable

Considering the needs of both groups is vital – the latter group pays the taxes which sustain the services used by the former. Without the support of those paying for the service we run the risk of the NHS being increasingly pushed into the role of safety net. That's not something I ever want to see nor, I suspect, is it what those who have responded robustly on social media want.

So let's look at offering services that are responsive to both the needs and expectations of the communities we serve. But let's also have some realistic public conversations about what is essential and what is desirable, what is achievable and what is affordable.

For me though, it is important to deal with fundamentals. And safety is a fundamental which needs to be tackled. NHS England's medical director, Sir Bruce Keogh, and the health secretary have seen the data. They say it shows a worrying weekend effect on mortality. We all need to see and understand the data and, if accurate, we cannot ignore it. It must be widely shared, interpreted and understood. We can then develop appropriate responses which may very well include increasing weekend services.

Dealing with safety is a priority, but it is also part of a wider debate about just how much of a seven day service we want. Is it everything, everyday? Probably not, but it is certainly more than we currently have. The questions we should be addressing are around what type of services do patients need, want and deserve at weekends. In turn, how far from this is current provision, and what do we need to do to get where we want to be? This needs proper analysis, honesty about our strengths and weaknesses, and thoughtful reflection about what can be done with the resources available.

As with every complex decision, there will be trade offs: in the end, we must have a service that is financially sustainable as well as attractive to the people who work in the service, because without them we will achieve nothing. It also means looking outside our walls. It would be easy to deliver more care in hospitals to speed throughput and then find we fail because we can’t get a strong social care service at the weekend to enable rapid discharge because of the financial pressures in those services.

Finally, it has been interesting to read the social media. Amongst it all, people have been pointing out that they are there but the scanners aren't running, that the laboratories are limited, that the infrastructure support of Monday to Friday care is not available. All the equipment that is shut down on a Friday evening is expensive and has been paid for. It is hugely wasteful for it to lie unused, but equally it would need additional resources to fund full use of it and boost safety and productivity.

Many hospitals do run elective surgery at weekends, and I had my flu jab on a Saturday at my local surgery. I haven’t met anyone – doctor, nurse, manager or politician – who believes these are the wrong ambitions or doubts the sincerity of those pursuing them. The secretary of state has said he wants to help the NHS make progress, so we must now tell him what we need to deliver, and then do it. This is a task for every part of the leadership of our provider organisations, and our patients deserve no less