NHS leader warns 20 maternity units may need to close

Up to 20 maternity units in England may need to close or change their role to keep mothers and babies safe, an NHS leader has warned.

Matthew Hopkins, the NHS Alliance’s director for acute care, told The Guardian that shortages of specialist doctors and rising caesarean section rates were making smaller maternity units increasingly difficult to sustain.

He called for childbirth services to be concentrated in fewer hospitals, acknowledging that the changes would be politically unpopular and force some expectant mothers to travel further to give birth.

Hopkins said as many as 20 of England’s 155 NHS maternity units led by consultant obstetricians, doctors specialising in pregnancy and childbirth, may need to close or change their role.

Units delivering between 1,500 and 2,000 babies a year were particularly vulnerable, with staffing shortages posing significant challenges in rural and coastal areas.

He argued that concentrating services in larger hospitals could improve safety by ensuring enough specialist staff and operating theatres were available.

Hopkins said: “Difficult decisions lie ahead, consolidating maternity services to support safer, more sustainable care.”

Hopkins described centralising maternity services as inevitable and urged ministers and MPs to support changes despite likely opposition from local communities.

His warning follows a sharp rise in caesarean sections, which involve delivering a baby through surgery.

Caesarean sections accounted for 45 per cent of births in England last year, up from 33 per cent in 2020, increasing demand for maternity staff and operating theatres.

Marian Knight, professor of maternal and child population health at the University of Oxford, has also suggested that the NHS consider concentrating maternity services in fewer, larger units to manage the increase.

The latest MBRRACE-UK report, which examines maternal deaths, found that some women who died during childbirth between 2022 and 2024 did so because their caesarean section was delayed or postponed when an obstetric surgeon or operating theatre was unavailable.

However, the proposals have drawn opposition from maternity professionals and politicians concerned about the loss of local services.

Hannah Leonard, chief policy officer at the Royal College of Midwives, said: “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.”

Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, questioned whether closures were the right response to staffing pressures.

“There are other solutions to our workforce challenges that are far safer than closing maternity units, and these should be explored.”

Recent service disruptions have shown the difficulties facing smaller maternity units.

The maternity unit at North Devon district hospital in Barnstaple temporarily closed in August because of understaffing, leaving expectant mothers facing journeys of approximately 43 miles to Exeter.

An estimated 194 women have given birth in Exeter because of the closure.

The Royal Devon university healthcare NHS foundation trust was expected to decide whether enough doctors were available to reopen the unit safely.

In Somerset, the maternity unit at Yeovil hospital reopened earlier this year after being closed for almost 12 months because of staffing shortages.

Helen Morgan, the Liberal Democrat health spokesperson, warned that closing rural and coastal services could put mothers and babies at risk.

Morgan said: “Forcing women in labour to travel an hour or more to the nearest hospital is unsafe, unacceptable, and leaves local communities abandoned.”

The debate comes ahead of a report from the government’s national maternity and neonatal taskforce, expected before Christmas, on how childbirth services can be improved.

Hopkins warned that the review risked failing to address underlying problems unless it considered how maternity services should respond to rising caesarean section rates.

A separate government-commissioned review of maternity care, published by Valerie Amos in June, identified poor infrastructure and insufficient political support for difficult decisions about service locations among concerns raised by senior figures.

The Department of Health and Social Care did not directly address the possibility of maternity unit closures.

A spokesperson said: “Every woman deserves safe maternity care, and the Secretary of State has made this issue a personal priority.

“Through the national maternity and neonatal taskforce, that she is chairing, this government will deliver the reforms needed to ensure services meet the needs of women and families now and in the future.”