As many as 20 consultant-led maternity units in England may need to close or change their role, an NHS leader has warned, arguing that births should be concentrated in fewer hospitals to ensure safe care. The figure is a warning about possible reorganisation, not an announcement that 20 named units will shut.

Matthew Hopkins, the NHS Alliance’s director for acute care, said shortages of doctors and rising caesarean rates were putting pressure on services. He called for a thorough review of where units are located, saying the current arrangement was not fit for purpose. Of England’s 155 NHS units led by consultant obstetricians, he said, up to 20 might need to close or change their role.

Hopkins told the Guardian that centralising births in fewer hospitals was inevitable and the right thing to do for patient safety. He acknowledged that the changes would be politically difficult. Some women would have to travel further to give birth, and ministers and MPs would need to support decisions that could prove unpopular locally.

Smaller units under pressure

Units delivering about 1,500 to 2,000 babies a year were becoming increasingly difficult to sustain, Hopkins said. Many of those most at risk were in rural or coastal areas, where recruiting and retaining staff was particularly challenging. Units without enough doctors could not provide the service required to keep mothers and babies safe, he argued.

The rise in caesarean births is adding to demands on maternity teams. Caesareans require obstetricians and operating theatres to be available, including for emergencies. The proportion of births in England delivered by caesarean rose from 33% in 2020 to 45% last year, according to figures cited in the report.

A recent MBRRACE-UK report found that some women who died during childbirth between 2022 and 2024 experienced delays or postponements to caesareans because a surgeon or operating theatre was unavailable. It said it was not clear whether services were maintaining safety as demand increased. Hopkins warned that further rises could create more difficult conditions for families and staff.

Midwives and obstetricians oppose closures

The Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists challenged the proposed direction. Hannah Leonard, the midwives’ college chief policy officer, said women and families depended on local maternity units and that high-quality care should be available close to home.

Dr Alison Wright, president of the obstetricians’ college, said other ways of addressing workforce problems were far safer than closing units and should be explored. Liberal Democrat health spokesperson Helen Morgan warned that making women in labour travel an hour or more would be unsafe and unacceptable, particularly in rural and coastal communities.

The debate comes as the Royal Devon University Healthcare NHS Foundation Trust was expected to decide whether North Devon District Hospital’s maternity unit in Barnstaple had enough doctors to reopen safely. It closed temporarily in August because of staffing shortages. Women from the area have had to travel to Exeter, 43 miles away, a car journey of about 70 minutes.

An estimated 194 women had given birth in Exeter during the closure, according to local reporting cited by the Guardian. That experience illustrates the practical access issue raised by opponents of centralisation: specialist staffing at a larger hospital must be weighed against the distance families face when their nearest service is unavailable.

Yeovil Hospital’s maternity unit reopened earlier this year after almost 12 months of closure because of staffing shortages. In Northern Ireland, Daisy Hill Hospital’s unit was earmarked for closure last month after recruitment efforts failed. These cases are separate from Hopkins’s warning about the future configuration of consultant-led services in England.

Government taskforce due to report

A government-commissioned maternity review published in June identified poor infrastructure and insufficient political backing for difficult reconfiguration decisions among challenges raised by senior figures. A maternity taskforce chaired by the Health Secretary is due to report before Christmas. Hopkins said it needed to address how the NHS would accommodate rising caesarean rates rather than avoid strategic questions.

The Department of Health and Social Care did not comment directly on possible closures. A spokesperson said every woman deserved safe maternity care and that the taskforce would deliver reforms to meet the needs of women and families now and in the future. The disagreement remains over how to achieve that safety while preserving access to care near home.