Matthew Hopkins, director for acute care at the NHS Alliance, has stated that centralizing maternity services by closing up to 20 of England’s 155 consultant-led obstetric units is necessary to maintain patient safety. He cited widespread obstetrician shortages and a significant increase in caesarean section rates as key drivers for the proposed consolidation. Units delivering only 1,500 to 2,000 babies annually are becoming unsustainable, particularly those located in rural and coastal areas where staffing challenges are most acute.
Hopkins acknowledged that consolidation would require mothers in affected areas to travel greater distances to receive care, but characterized the changes as inevitable and essential for providing safe, high-quality services. He emphasized that maternity units lacking sufficient medical staff cannot deliver the level of care needed to ensure patient safety. Hospital leaders have expressed concern that an upcoming government maternity taskforce report, expected before Christmas, may not adequately address the strategic issues underlying current service problems, particularly regarding how the NHS will accommodate increased demand for caesarean sections, which require additional staff and operating theatre capacity.
The proposal has generated substantial opposition from medical organizations. The Royal College of Midwives and Royal College of Obstetricians and Gynaecologists have advocated for maintaining local maternity services, with representatives arguing that alternative solutions to workforce challenges should be explored before closing units. Politicians, including health officials who acknowledged in September that maternity services face structural issues, have expressed concern about forcing expectant mothers to travel extended distances for care. An estimated 194 women have already given birth in a distant hospital due to a temporary closure affecting North Devon district hospital in Barnstaple.
Research data indicates caesarean section rates increased from 33% of births in England in 2020 to 45% in the most recent year. Studies investigating maternal deaths found that some women died during childbirth between 2022 and 2024 because caesarean sections were delayed or postponed due to unavailable surgical staff or operating theatres. Hopkins warned that without action, further increases in caesarean section rates could force reactive closures in the future.
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