Matthew Hopkins, director for acute care at the NHS Alliance, has stated that centralizing maternity services into fewer hospitals is necessary to maintain safe care for mothers and babies. He indicated that as many as 20 of England’s 155 NHS maternity units led by consultant obstetricians may need to shut or alter their roles to address systemic challenges.
Hopkins cited two primary factors driving the need for consolidation: widespread shortages of obstetrician staff and a significant increase in cesarean section rates. Smaller units delivering between 1,500 and 2,000 babies annually are becoming increasingly unsustainable, he said, with units in rural and coastal areas facing particularly acute staffing difficulties. Hopkins called for a comprehensive review of maternity service locations, arguing the current distribution is no longer fit for purpose and that politicians must demonstrate courage in supporting difficult reconfigurations, even though affected mothers would face longer travel distances to access care.
The proposal immediately drew criticism from professional organizations. Hannah Leonard, chief policy officer of the Royal College of Midwives, stressed that women and families depend on local maternity units and that high-quality services should remain accessible near people’s homes. Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, contended that other solutions to workforce challenges exist that would be safer than closures. Helen Morgan, the Liberal Democrat health spokesperson, warned that forcing women in labor to travel extended distances is unsafe and unacceptable.
The debate emerged amid several real-world service disruptions. A maternity unit in Barnstaple was temporarily shut in August due to understaffing, and an estimated 194 women delivered in Exeter as a result. A maternity unit in Somerset reopened earlier this year after nearly 12 months of closure due to insufficient staffing. Academic research has documented that cesarean section rates rose from 33% of births in England in 2020 to 45% the following year. Recent maternal mortality investigations found that some women died during childbirth between 2022 and 2024 because cesarean sections were delayed or postponed due to unavailable obstetric surgeons or operating theatres.
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