NHS leaders warn up to 20 maternity units in England may close

NHS leaders warn of maternity closures

Up to 20 small maternity units in England may have to close or change their role, according to the NHS Alliance, a group representing senior NHS leaders. It says current maternity services are not fit for purpose. The warning is based on staff shortages, difficulties finding midwives and consultants to provide safe 24-hour cover, and a sharp rise in caesarean sections. The group also says some operating theatres and buildings can be inadequate for high-quality care.

Caesarean sections, both planned and emergency, now account for more than 40% of births in England, and one report put the figure at about 45%. Some smaller units deliver babies with medical intervention more than 50% of the time. By comparison, some other health systems have caesarean rates of 30% or less. Experts have linked the rise to factors including older mothers, obesity and medical conditions. NHS leaders argue that if the caesarean rate keeps rising, investment alone will not be enough and service change, including possible consolidation, will be needed.

The local impact is already visible in North Devon. Birthing services at Barnstaple hospital have been suspended temporarily, and pregnant women have to make a 53-mile journey to Exeter. The trust said the temporary closure was the only safe course of action because of staffing issues. Campaigners have held protests and say some babies have been born in ambulances, in Exeter reception, and in cars that turned back to Barnstaple, where the A&E is not set up for maternity care.

The Royal College of Midwives has criticised the proposed closures, saying high quality maternity services must remain accessible close to families' homes. A medical negligence solicitor said every mother is entitled to safe maternity care wherever she lives, and warned that longer journeys can be catastrophic for women in rural and coastal areas when complications arise quickly. She called for a clear appraisal of safety that looks beyond the size of a unit and for mothers' concerns to be listened to.

The NHS Alliance is urging local and national politicians to have the courage to make the case for patient safety and for changes to the system. The Department of Health said a national task force would deliver reforms in England to ensure services met the needs of women and families, now and in the future. It said a full action plan is due in December, and that £271 million has already been invested since last spring to improve safety.