The Herald's campaign to highlight the dangers of emergency department overcrowding during the winter months is very welcome ("Warning as hospital deaths rise" and "NHS winter death figures reinforce case for review", The Herald, August 30).

The sheer volume of evidence that now exists for the harm associated with overcrowded emergency departments from around the world is such that no-one who had read into this subject in any detail can be left in any doubt as to its importance.

Based mainly on research from high-functioning departments in Australia, it is now widely accepted that patients who are admitted via an emergency department experiencing significant delays and overcrowding are more likely to die. The mechanism of this excess mortality is likely to be a complex interplay of errors and omissions committed by overstretched staff, delays to time-critical treatments such as antibiotics and surgery, and increased risk of complications such as bed sores, blood clots and infections caused by prolonged waits on trolleys. In addition, there is also good evidence from Canada that patients discharged from overstretched emergency departments are also more likely to die. This is likely to be due to staff being too distracted by having to provide ongoing care for patients awaiting a bed to scrutinise and review those being discharged adequately.

Overall, the additional mortality associated with hospital overcrowding was felt by the Australasian College of Emergency Medicine in 2009 to be roughly equivalent to the number of people killed on the roads each year. Emergency department staff across Scotland will be looking to the health minister and his team for leadership on this key patient safety issue to avoid our own "road toll" of overcrowding deaths. This begins by acknowledging the clear-cut evidence of the harm associated with hospital overcrowding and setting collective high-level goals. Perhaps "no patient shall wait more than 30 minutes on a trolley in an emergency department for a bed" would be a modest (and achievable) aim for this winter.

Tim Parke,

Emergency Department Consultant,

Glasgow.

Our GP organised my husband to be admitted to A&E at the Western Infirmary in Glasgow in need of hydration and other tests, and, because of his very weak state, requested an ambulance. It wasn't an emergency, and we expected to wait, although not for five-and-a-half hours. The ambulance controller telephoned several hours after the initial request to say there had been many emergencies, but he would do his best to get an ambulance to us. After four hours, I phoned central control, who replied that there was an ambulance looking for us in the vicinity, and would I go out on to the main road to try to flag it down because it couldn't find us. This, on one of the main thoroughfares in Glasgow.

I was asked for directions. The controller didn't know where Gartnavel Hospital, Great Western Road or Anniesland Cross are. When the ambulance staff eventually arrived, they had been misdirected to Kelvindale and Cleveden Road. They came from the south side of Glasgow and had been co-opted to cope with the emergency situation, so it wasn't their fault that it took them 1 hour 40 minutes to find us. My husband and I were in quite a distressed state by this time.

When we eventually arrived at A&E I obtained the last seat in the waiting area, which was full of people, half of whom should not have been there. One lady had had a sore leg for a week, hadn't contacted her GP and chose to arrive at A&E on a Friday evening. The A&E staff were wonderful, and despite my husband having to wait four-and-a-half hours before seeing a doctor who could authorise a drip, we have only praise for the overworked and undervalued staff.

However, many of the problems at A&E can be attributed to the public, who abuse the facility unnecessarily, and the fact GP surgeries are shut at weekends. If we went back to the days when doctors were available any time of day or night - though I'm sure they will disagree - it would greatly relieve the pressure on A&E and the availability of hospital beds. Pay GPs extra money to be available out of hours and in the long run it will save the NHS money.

Lesley Mackiggan,

61 Kelvin Court,

Glasgow.

It was with disappointment and frustration that we read the results of the Scottish Drugs Strategy and Delivery Commission's review into opiate replacement therapy ("Care of drug users branded 'inconsistent'", The Herald, August 23). Of the 12 recommendations the review makes, not one included a pledge to introduce - or even put to clinical trial - what the evidence suggests is the one of the best available treatment options: heroin-assisted treatment (HAT).

The rationale for HAT is the same as that with methadone. It accepts that abstinence is, at a certain point in time, often an unrealistic aspiration for many addicted people and takes a pragmatic decision to provide them with a safer, cleaner medical alternative. This allows them to hold down a stable, unchaotic life, taking them away from the dangers of adulterated street heroin, and helping to wean them off drugs inch by cautious inch.

Such a strategy has a considerable body of evidence to support it. Under medical trials in England, for example, some 72% of recipients of HAT refrained from using street heroin. In Switzerland, the number of users of street heroin fell from 81% to 18% after 18 months. Cumulatively, with methadone and drug consumption rooms, it has brought about a 50% drop in the mortality rate. In the Netherlands, the number refraining from the use of street heroin rose to 86% in four years.

Scotland has one of the highest rates of heroin use in Europe, and with drug deaths the highest on record in 2011, a better approach has never been more urgent. When will the Scottish Government and medical experts accept the evidence and embrace one of the best treatment options available?

Stuart Rodger,

Transform Drug Policy Foundation (Scotland),

2 Scotmill Way,

Inverkeithing, Fife.