Up to 20 English Maternity Units Face Possible Closure

Published: 19 October 2026. The English Chronicle Desk. The English Chronicle Online

Up to 20 maternity units across England could be forced to close or change their role as the National Health Service confronts staff shortages, rising caesarean section rates and growing concerns about the safety of childbirth services. A senior NHS leader has warned that concentrating maternity care in fewer hospitals may become unavoidable, reigniting a debate over whether centralisation can improve clinical standards without leaving women in rural and coastal communities facing longer and potentially dangerous journeys to give birth.

Matthew Hopkins, director for acute care at the NHS Alliance, has urged ministers and parliamentarians to confront what he described as difficult but necessary decisions about the future location of maternity services. England currently has 155 maternity units led by consultant obstetricians, and Hopkins believes as many as 20 may need to close or substantially change their responsibilities to ensure care remains safe and sustainable.

The proposal reflects mounting pressure on maternity departments, particularly smaller hospitals that deliver approximately 1,500 to 2,000 babies annually. According to Hopkins, these units are increasingly struggling to maintain adequate medical staffing while responding to changes in childbirth patterns. A shortage of obstetricians, combined with growing demand for caesarean sections, has made it more difficult for some hospitals to guarantee that specialist doctors and operating theatres will be available when complications arise.

Hopkins has argued that the current distribution of maternity services is no longer suitable for the demands placed on the NHS. He has called for a comprehensive assessment of where services should be located, warning that maintaining every existing unit regardless of staffing levels could compromise patient safety. In his view, concentrating specialist teams in fewer hospitals could help ensure that women receive appropriate treatment when emergencies occur.

However, the proposal has provoked an immediate backlash from midwives, obstetricians, politicians and campaigners who fear that closures could place additional burdens on expectant mothers. For many families, a nearby maternity unit provides reassurance that professional help is accessible during labour. Losing that service could mean longer journeys, greater dependence on transport and increased anxiety for women who may already be dealing with difficult pregnancies.

The disagreement highlights a fundamental challenge for the health service: how to balance the clinical advantages of specialist concentration against the practical importance of local access. Supporters of consolidation argue that hospitals need enough doctors, midwives, operating facilities and other specialist resources to manage unpredictable complications. Opponents warn that closing local units could create new risks, especially when labour progresses quickly or a woman requires urgent medical attention.

The growing use of caesarean sections is central to the debate. These procedures can be essential for protecting the health of mothers and babies, but they require trained surgical staff, anaesthetists, operating theatres and appropriate recovery facilities. If several women require urgent procedures at the same time, a hospital with insufficient staffing or theatre capacity may struggle to respond promptly.

Figures cited in the debate show that caesarean sections accounted for approximately 33 per cent of births in England in 2020, rising to 45 per cent last year. The increase has intensified questions about whether smaller maternity departments can provide the necessary level of specialist support around the clock. Hopkins has warned that if the proportion continues to rise towards 55 or even 65 per cent, the pressure on existing arrangements could become considerably more severe.

Concerns about the consequences of delayed treatment have also been raised by researchers investigating maternal deaths. The latest report from the MBRRACE-UK programme found that some women who died during childbirth between 2022 and 2024 experienced delays or postponements to caesarean sections because an obstetric surgeon or operating theatre was unavailable. The report questioned whether the safety of maternity services was being maintained as demand for these procedures increased.

Professor Marian Knight, an expert in maternal and child population health at the University of Oxford who investigates maternal deaths through the programme, has supported consideration of consolidating services into fewer, larger units. Larger departments could potentially maintain more extensive specialist teams and provide greater capacity to deal with simultaneous emergencies. Yet the debate remains complex because larger hospitals must also be able to accommodate increased patient numbers without creating new pressures on staff and facilities.

Hopkins has warned that postponing difficult decisions could leave the NHS reacting to a worsening situation rather than planning for it. He has urged politicians to demonstrate the courage needed to support changes that may be unpopular locally but, in his view, could improve patient safety over time. He also cautioned that a government review of maternity care would achieve little if it avoided the underlying questions about staffing, hospital capacity and the organisation of services.

His intervention comes as the government prepares to receive recommendations from its national maternity and neonatal taskforce before Christmas. The taskforce is expected to examine ways of improving childbirth care and addressing longstanding problems in services across England. Hospital leaders fear that recommendations will fall short if they do not provide a clear strategy for responding to rising caesarean demand and persistent workforce shortages.

The controversy is already visible in North Devon, where the maternity unit at North Devon District Hospital in Barnstaple was temporarily closed in August because of insufficient staffing. The local NHS trust, Royal Devon University Healthcare, was expected to decide this week whether enough doctors had been recruited to allow the unit to reopen safely. During the closure, an estimated 194 women had to give birth in Exeter instead.

Exeter is approximately 43 miles from Barnstaple, a journey that can take around 70 minutes by car. For women approaching labour, particularly those experiencing complications or having their first baby, such a distance can create considerable concern. The situation has become a prominent example of the practical consequences that can follow when a hospital cannot maintain an adequately staffed maternity department.

Andy Burnham, who appeared at prime minister’s questions on 2 September, acknowledged that maternity services across the United Kingdom faced structural problems. He said it was unacceptable for expectant mothers in North Devon to have to travel to Exeter because their local service was unavailable. The case illustrates why proposals for further consolidation are likely to encounter strong resistance from communities that already have limited access to specialist healthcare.

Other hospitals have experienced similar difficulties. The maternity unit at Yeovil Hospital in Somerset reopened earlier this year after remaining closed for almost 12 months because of staffing shortages. In Northern Ireland, the maternity service at Daisy Hill Hospital in Newry was recently identified for possible closure for the same reason. Efforts to recruit obstetricians from within the United Kingdom, Ireland and internationally had failed to resolve the staffing problem.

Rural and coastal communities are particularly vulnerable because hospitals in these areas can struggle to attract and retain specialist staff. A closure may leave residents with fewer alternatives, while travel times can be affected by road conditions, weather and the availability of transport. Critics argue that any plan to centralise maternity services must account for these realities rather than focusing exclusively on staffing numbers and hospital efficiency.

Helen Morgan, the Liberal Democrat health spokesperson, warned that forcing women in labour to travel for an hour or more to reach the nearest maternity hospital could be unsafe and unacceptable. She argued that ministers should not allow rural and coastal communities to lose essential services without thoroughly examining the consequences. Her concerns reflect wider fears that the drive to reorganise the NHS could deepen inequalities between people living in major urban centres and those in more remote areas.

Professional organisations have also challenged the idea that closures are the best answer to workforce shortages. Hannah Leonard, chief policy officer at the Royal College of Midwives, said women and families depended on maternity services being available close to home and that efforts should focus on ensuring high-quality care locally. Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists, said other approaches to workforce difficulties should be explored before units were shut.

Those alternatives could include improving recruitment and retention, strengthening staffing arrangements, supporting training and ensuring that hospitals have the facilities required to manage changing patterns of care. However, these measures take time and require sustained investment. The experience of hospitals that have struggled to recruit enough obstetricians demonstrates the difficulty of maintaining services when vacancies remain unfilled despite repeated efforts.

A government-commissioned review led by Valerie Amos, published in June, also highlighted significant challenges facing maternity care. Senior figures consulted during the review pointed to inadequate infrastructure, unsafe or unacceptable hospital buildings and insufficient political support for difficult decisions about reorganising services. The findings reinforced concerns that the problems extend beyond individual hospitals and require a coordinated national response.

The Department of Health and Social Care declined to comment directly on the possibility of 20 maternity unit closures. A spokesperson said every woman deserved safe maternity care and that the health secretary had made improvements a personal priority. The government said its national maternity and neonatal taskforce would develop reforms intended to ensure services meet the needs of women and families both now and in the future.

For expectant parents, the debate is about more than hospital structures or administrative efficiency. It concerns whether help will be available when labour begins, whether emergency surgery can be provided without delay and whether families will have to travel significant distances during one of the most vulnerable periods of their lives.

The decisions facing ministers are therefore likely to be politically sensitive as well as clinically complex. Closing a maternity unit can cause lasting concern in a community, while keeping a service open without sufficient staff and facilities may also carry serious risks. Any reorganisation will need transparent evidence, meaningful consultation and a clear explanation of how women and babies will be protected.

As the government prepares its next steps, the central question is whether England can develop a maternity system that is both safe and accessible. Consolidation may offer some hospitals a way to maintain specialist expertise, but the consequences for rural families cannot be ignored. The challenge for the NHS will be to address shortages and rising demand without creating new barriers to essential care for the women and babies who depend on it.