NHS managers’ group raises prospect of smaller maternity unit closures

The NHS Alliance, which represents health managers, says some smaller maternity units in England may have to close because staffing and facilities are putting safe care at risk. But an independent national investigation has warned that the effect of unit size on safety is not yet well enough understood to conclude that consolidation would make care safer overall. [1] [3]

Matthew Hopkins, director of the Alliance’s acute and ambulance network, told the BBC: “Difficult decisions lie ahead, consolidating maternity services to support safer, more sustainable care.” The Alliance said units handling around 1,500 to 2,000 births a year might need to close, particularly where smaller services struggle to maintain round-the-clock staffing. That range is a suggestion from the group, not an announced national closure rule. [1]

The pressures behind the warning are real. The Alliance cited shortages of specialist staff and too few operating theatres and beds as caesarean births increase. An investigation led by Baroness Valerie Amos found that caesarean sections accounted for 45% of births in 2024/25, up from 30% in 2018/19. Staff at the NHS trusts it visited described cases where theatre space and postnatal beds had not kept pace. Hopkins had also raised concerns about safe staffing in smaller units in a September statement. [1] [2] [3]

The Amos investigation found advantages and difficulties at both ends of the scale: smaller units can offer more personalised care but may struggle to sustain specialist cover; larger units can draw on broader expertise but face pressures on capacity and continuity of care. It recommended a review of the best size and configuration of services, saying more work was needed to understand the links between unit size, safety and outcomes. [3]

Catherine Mchomvu of the Devon Antenatal Family Centre told the BBC she feared closures would undermine continuity of care. The Amos report likewise describes seeing the same midwife or small team as important to safety, although neither account establishes what would happen under a particular plan to combine services. Hopkins said local plans should involve staff, patients and communities.