BANNING walk-in patients from attending the emergency department (Echo, Oct 14) without a prior referral is a health policy based on mythology, not on science.

Crowding in the emergency department is a function of a crowded hospital. It rarely occurs when hospital bed occupancy rates are 85 per cent but is a given at 95 per cent.

With a crowded hospital, there is an inability to transfer admitted patients to the appropriate wards, treatment stretchers in the A&E are occupied and the waiting room and ambulance bays become back logged.

The way to solve a crowded ER is to improve bed access within the hospital.

Furthermore decades of international medical literature is also very clear that walk-in patients do not significantly contribute to crowding and discouraging them from going to the A&E is a strategy that has never worked.

Not only that but there is a significant risk that patients with serious illness may suffer harm if diverted away from the emergency department.

There is ample evidence that patients deemed retrospectively to be nonurgent have an admission rate of five per cent.

Sometimes simple indigestion is actually a heart attack; sometimes a fussy baby is a septic one.

The NHS needs a second opinion but in ours, this is just plain dumb.

Alan Drummond MD, International Federation of Emergency Medicine