Matthew Hopkins, director for acute care at the NHS Alliance, has cautioned that consolidating maternity services into fewer hospitals is necessary to maintain safety standards across England’s healthcare system. He indicated that as many as 20 of the country’s 155 NHS consultant-led maternity units may require closure or operational changes. Hopkins stated that smaller units delivering only 1,500 to 2,000 babies annually are becoming increasingly unsustainable, particularly those located in rural and coastal regions where recruitment of obstetricians proves especially difficult.
The push for consolidation stems from two primary factors: widespread shortages of obstetric doctors and a marked increase in caesarean section rates. Caesarean sections rose from 33% of births in England in 2020 to 45% in the most recent year cited, requiring maternity units to maintain additional staff and operating theatre capacity. Hopkins emphasized that units lacking sufficient medical personnel cannot provide adequate service levels to ensure patient safety. He acknowledged that such reconfigurations would prove politically contentious and require affected mothers to travel greater distances to reach birthing facilities.
The remarks generated swift opposition from professional bodies representing midwives and obstetricians. The Royal College of Midwives and Royal College of Obstetricians and Gynaecologists both countered that maternity services should remain accessible near patients’ homes and that alternative solutions to workforce challenges exist. Helen Morgan, the Liberal Democrat health spokesperson, characterized forced travel during labor as unsafe and unacceptable, particularly for those in rural areas.
Hopkins’s position aligns with findings from the MBRRACE-UK research program investigating maternal deaths. Recent reports indicate that some maternal deaths between 2022 and 2024 occurred when caesarean sections were delayed or postponed due to unavailable surgeons or operating theatres. Hopkins cautioned that if caesarean rates continue rising to 55% or 65%, reactive rather than planned consolidation efforts would become inevitable. His comments preceded an anticipated government maternity taskforce report scheduled for release before Christmas.
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