The NHS Alliance, which speaks for health service managers in England, said on Monday that the way maternity care is organised is "not fit for purpose" and warned that some smaller units delivering between 1,500 and 2,000 babies a year may have to close if safety is to improve.
The intervention lands as the Department of Health and Social Care runs a neonatal and maternity taskforce promised after repeated scandals over avoidable harm. Ministers say every woman deserves safe care and that the taskforce will deliver reforms; the alliance's message is that structural consolidation, not incremental tweaks, is now on the table.
Pressures managers cite
In a briefing to journalists, the group pointed to rural and coastal units that struggle to keep 24-hour consultant and midwife cover, ageing buildings with too few operating theatres and beds, and a steady rise in caesarean sections that strains theatres already booked for emergencies. Matthew Hopkins, director of the alliance's acute and ambulance network, said "difficult decisions lie ahead" and that services must be consolidated to support safer, more sustainable care.
Politicians, he added, need "the courage to make the case for patient safety" when local communities resist change. Any reorganisation should involve clinicians, patients and the public, not be imposed from Whitehall alone.
Where closures are already felt
The warning is not abstract. The Royal Devon University Healthcare NHS Foundation Trust suspended standard birthing at North Devon District Hospital in Barnstaple in August, leaving some expectant mothers facing a 53-mile trip to Exeter. The trust cited staffing as the only safe option after exhausting locum cover and said a readiness assessment would follow later in October.
Campaigners told the BBC the delay is disappointing; one couple described anxiety about making the longer journey for a second birth. Catherine Mchomvu, chief executive of the Devon Antenatal Family Centre, said further closures nationally would erode continuity of care because families would rarely see the same team twice.
Equity on the agenda
The alliance tied consolidation to wider inequity: significantly worse outcomes in deprived communities and higher maternity mortality rates for Black and Asian women documented in national data. Hopkins said the taskforce must "grasp the nettle" on those strategic issues, not only on individual hospital failings.
The government reiterated that the taskforce will shape services "now and in the future." For managers, the sharper question is whether ministers will back unpopular mergers when a general election cycle makes every local closure a political fight — and whether consolidation, if it comes, is paired with transport, midwifery continuity and targeted equity funding rather than simply fewer beds on the map.