Up to 20 maternity units in England may have to close, NHS leader warns

As many as 20 of England's 155 consultant-led maternity units may need to close or change their role to keep mothers and babies safe, a senior NHS leader has warned.

Matthew Hopkins, director for acute care at the NHS Alliance, told the Guardian that concentrating childbirth in fewer hospitals was "inevitable" and "the right thing", but would bring a political backlash.

Why units are under pressure

Hopkins said smaller units delivering only 1,500 to 2,000 babies a year were becoming unsustainable because of a shortage of obstetricians and a sharp rise in caesarean sections, which need more staff and operating theatres. Caesareans rose from 33% of births in England in 2020 to 45% last year.

Many of the units most at risk are in rural or coastal areas, where recruiting staff is hardest. "Difficult decisions lie ahead, consolidating maternity services to support safer, more sustainable care," he said, urging politicians to find the "courage to grasp the nettle".

Safety concerns

The latest report from MBRRACE-UK, which investigates maternal deaths, found that some women who died in childbirth between 2022 and 2024 did so because a caesarean was delayed when no obstetric surgeon or theatre was available. Professor Marian Knight, of the University of Oxford, has said the NHS should consider fewer, bigger units.

"Close to home"

The warning drew an immediate backlash. 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, said: "There are other solutions to our workforce challenges that are far safer than closing maternity units." Helen Morgan, the Liberal Democrat health spokesperson, said forcing women in labour to travel an hour or more was "unsafe, unacceptable".

Units already shut

The maternity unit at North Devon District Hospital in Barnstaple closed temporarily in August because of understaffing, and Yeovil's reopened earlier this year after almost 12 months shut. Andy Burnham told MPs in September that maternity services were facing "structural issues".

The government's maternity taskforce, chaired by the health secretary, is due to report before Christmas. The Department of Health said: "Every woman deserves safe maternity care, and the Secretary of State has made this issue a personal priority."

Birmingham

Birmingham's maternity services are mostly in large units, including Birmingham Women's Hospital, the Queen Elizabeth's neighbour in Edgbaston, and the units at Heartlands and Good Hope hospitals, which deliver thousands of babies a year. Larger urban units are generally better placed to staff round-the-clock consultant cover than small rural ones.

Expectant parents with concerns about their care can speak to their midwife or the hospital's maternity voices partnership, which represents families.