Up to 20 maternity units in England will have to shut to ensure mothers and babies receive safe care amid shortages of doctors and rising caesarean section rates, an NHS leader has warned.
Matthew Hopkins, the NHS Alliance’s director for acute care, said centralising childbirth services into fewer hospitals was “inevitable” and the “right thing”, but would lead to a political backlash against unpopular changes.
Ministers must “grasp the nettle” that as many as 20 of England’s 155 NHS units that are led by consultant obstetricians will need to shut or change their role, he added.
Hopkins urged ministers and MPs to show “courage” by backing major changes to where maternity services are located, even though reconfigurations will lead to mothers-to-be in affected areas being forced to travel further to have their babies.
Smaller maternity units that deliver only 1,500 to 2,000 babies a year are becoming increasingly unsustainable because of a widespread lack of obstetricians and a sharp rise in recent years in the number of women having either a planned or emergency caesarean section, he added.
Many of the units most at risk are in rural or coastal areas, where staffing is particularly challenging, he told the Guardian. “We are calling for a thorough appraisal of maternity services and where they need to be located because the current configuration is not fit for purpose,” Hopkins said.
“Difficult decisions lie ahead, consolidating maternity services to support safer, more sustainable care.
“If politicians … are keen to see safe maternity services in their area, it is going to need courage to grasp the nettle that needs to be grasped in order to improve maternity services.”
Consolidation of care at fewer sites was “inevitable” and represented “doing the right thing … the safe thing for patients”, he said. Maternity units with too few doctors could not provide the level of service needed to ensure safety, he stressed.
Hospital bosses fear that the government’s maternity taskforce, which is due to publish a report on improving childbirth care before Christmas, “will be tokenistic and won’t deal with the real strategic issues that underpin the problems” if it does not set out clearly how the NHS should accommodate the rise in caesarean sections, which require units to have more staff and more operating theatres, Hopkins added.
But his comments provoked an immediate outcry, with obstetricians and midwives insisting that maternity care should remain a service the NHS provides near people’s homes. “Women and families rely on local maternity units to be there when they need them, and we must ensure there are high-quality services close to home,” said Hannah Leonard, the chief policy officer of the Royal College of Midwives.
Dr Alison Wright, the president of the Royal College of Obstetricians and Gynaecologists, said: “There are other solutions to our workforce challenges that are far safer than closing maternity units, and these should be explored.”
Hopkins’s comments came as the Royal Devon university healthcare NHS foundation trust was expected to decide this week if the maternity unit at North Devon district hospital in Barnstaple, which shut temporarily in August due to understaffing, now has enough doctors to allow it to safely reopen.
Andy Burnham, in his first appearance at prime minister’s questions on 2 September, admitted that maternity services across the whole UK were facing “structural issues”. Burnham told the Liberal Democrat leader, Ed Davey, it was “not acceptable” for expectant mothers from north Devon to have to give birth in Exeter, which is 43 miles – and a 70-minute car journey – from Barnstaple.
An estimated 194 women have had their child in Exeter because of the closure.
The maternity unit at Yeovil hospital in Somerset reopened earlier this year after being shut for almost 12 months because it had too few staff. The maternity unit at Daisy Hill hospital in Newry, in Northern Ireland, was last month earmarked for closure for the same reason. Strenuous efforts by NHS bosses to recruit obstetricians from Ireland, the UK and internationally to work there failed.
Closing rural and coastal units would put mothers and babies in danger, said Helen Morgan, the Liberal Democrat health spokesperson. “Forcing women in labour to travel an hour or more to the nearest hospital is unsafe, unacceptable, and leaves local communities abandoned,” she said, adding that ministers must not allow maternity services in rural and coastal areas to be “shuttered”.
Hopkins – who has run four hospital trusts – is not the first senior figure to argue for major reconfiguration of maternity services to improve the quality and safety of care.
Marian Knight, a professor of maternal and child population health at the University of Oxford, who investigates maternal deaths as part of the MBRRACE-UK research programme, told the Health Service Journal last month that the NHS should consider “consolidation into fewer, bigger [maternity] units to help medical teams manage the surge in C-sections”. They rose from 33% of births in England in 2020 to 45% last year.
Some women who died during childbirth between 2022 and 2024 did so because their caesarean section was delayed or postponed because an obstetric surgeon or operating theatre was not available, the most recent MBRRACE-UK report found. “It was not clear if the safety of services is maintained in light of [the] increased demand [for caesarean sections]”, it said.
Urging immediate action on centralisation of care, Hopkins added: “If this C-section rate becomes 55% or 65%, [that] inevitably will force reactive actions being taken. In our view, [and] Marian’s view, we need to grasp the nettle and get ahead of what could be really difficult conditions for mums, babies and staff if this rate of increase in C-sections continues to rise.”
In her government-commissioned review of maternity care in June, Valerie Amos revealed that senior figures in the field had told her that key challenges to improving care included “poor infrastructure, with, at times, unsafe and unacceptable estates … and too little (political) backing for difficult reconfiguration decisions.”
The Department of Health and Social Care was approached for comment.
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