NHS leaders urge maternity service consolidation as smaller units face staffing pressures

NHS leaders in England warned on 19 October 2026 that the organisation of maternity care was putting safety at risk, calling for services to be concentrated at fewer sites as smaller units struggle with staffing shortages and increasing demand for caesarean births.¹²

The case for fewer sites

The NHS Alliance, which represents health managers, says the existing arrangement cannot adequately meet maternity care needs. Matthew Hopkins, director of its acute and ambulance network, told the Guardian that consolidation could be necessary in 20 places. The newspaper reported that up to 20 of England’s 155 consultant-led NHS maternity units might close or take on a different role.¹²

Units handling between 1,500 and 2,000 births annually could face closure, according to the Alliance. It says smaller services, particularly in rural and coastal communities, can struggle to provide sufficient midwifery and obstetric cover around the clock. Hopkins argues that bringing services together would help protect patients.¹²

The Alliance also identifies insufficient operating theatres and beds, deteriorating buildings and the growing number of caesarean deliveries as safety concerns. According to the Guardian, caesareans accounted for 45% of births in England last year, compared with 33% in 2020.¹²

Hopkins cited two trusts where combining childbirth services from two sites into one had improved outcomes for mothers and babies. The Guardian also reported that centralisation helped the Worcestershire trust secure a good maternity-service rating from the Care Quality Commission.²

Access to local care

The Royal College of Midwives says families need high-quality maternity care near their homes. Alison Wright, who leads the Royal College of Obstetricians and Gynaecologists, said staffing difficulties could be tackled in other, safer ways without shutting maternity units.²

In Barnstaple, standard birthing services were suspended in August because of staffing problems, requiring affected pregnant women to travel 53 miles to Exeter. In October, the Royal Devon trust said the North Devon service would stay suspended until an assessment determined whether it was ready to reopen.¹

The trust said it had investigated temporary medical cover and help from other health organisations before deciding suspension was the “only safe course of action”. Facility campaigner Catherine Mchomvu, who heads the Devon Antenatal Family Centre, warned that a nationwide shutdown of smaller units would weaken both the consistency and standard of care.¹

Decisions for the taskforce

A taskforce established by the government is drawing up recommendations for improving maternity and neonatal services. The Alliance wants it to confront specialist staffing shortages and the capacity needed for rising caesarean deliveries. According to the Guardian, some trust leaders fear the government’s plans may sidestep decisions about closing units.¹²

The Alliance also says maternity outcomes are substantially worse in deprived communities and mortality rates are higher for Black and Asian women. Baroness Valerie Amos’s review found in June that women and babies were not being heard and that racism and discrimination were embedded across the system.¹

Hopkins said plans for each area should be developed with input from health-service managers, clinicians, patients and local residents. According to the health and social care department, all women should have access to safe maternity care, and the taskforce would produce the changes necessary to serve women and their families.¹