An NHS leader has warned that as many as 20 maternity units in England could close or change their role amid shortages of specialist doctors, increasing caesarean births and pressure on hospital resources. Healthcare professionals are calling for investment in recruitment, retention and safer working conditions.
Up to 20 NHS maternity units across England could face closure or major restructuring, following warnings that shortages of specialist healthcare professionals are making some smaller services increasingly difficult to operate.
Matthew Hopkins, director for acute care at the NHS Alliance, has called for a national review of maternity services, arguing that some hospitals may struggle to maintain sufficient staffing and facilities to provide safe care around the clock.
According to reporting published by The Guardian on 19 October, the proposals could affect approximately 20 of England’s 155 consultant-led maternity units, particularly smaller hospitals in rural and coastal communities.
However, no national decision has been made to close 20 maternity units. The figure represents an estimate put forward during a debate about the future organisation of maternity services, rather than an approved closure programme.
For thousands of NHS employees, the developments raise important questions about job security, recruitment, workloads, redeployment and the future of local healthcare services.
NHS staffing shortages place maternity services under increasing pressure
Maternity services depend on a combination of skilled professionals, including midwives, obstetricians, anaesthetists, neonatal specialists, theatre staff and maternity support workers.
Smaller hospitals can experience particular difficulties recruiting enough specialist employees to maintain safe services throughout the day and night.
Hopkins has warned that units handling approximately 1,500 to 2,000 births annually may struggle to provide sufficient specialist cover and operating-theatre capacity.
He argues that concentrating some maternity services in larger hospitals could help improve access to specialist teams and facilities.
However, this approach could also require patients to travel further and potentially result in NHS employees being transferred to different workplaces.
The Royal College of Obstetricians and Gynaecologists (RCOG) has acknowledged serious staffing difficulties, reporting gaps across maternity rotas throughout the country.
It has called for sustained investment in recruitment, training, retention and appropriate facilities rather than treating closures as the inevitable solution.
Caesarean births increase demand for specialist NHS staff
Another important factor is the growing proportion of babies delivered by caesarean section.
Recent reporting indicates that approximately 45% of NHS births in England now involve caesarean delivery.
This places additional demands on obstetricians, anaesthetists, theatre teams and other maternity professionals.
Hospitals must have sufficient specialist employees available to respond to planned procedures and unexpected emergencies.
The increase also highlights the importance of adequate staffing, appropriate training and access to modern medical facilities.
For NHS workers already experiencing demanding workloads, shortages of qualified colleagues can create additional pressure.
The debate is therefore about more than the location of maternity services. It concerns whether hospitals have the resources and staffing arrangements necessary to provide safe care.
Previous warnings highlighted newly qualified midwives struggling to find NHS jobs
The latest developments follow earlier concerns about the recruitment of newly qualified midwives.
In our previous investigation, NHS under fire as student midwives face job crisis despite staff shortages, we reported that many student midwives were struggling to secure employment despite completing extensive training and clinical placements.
The article highlighted concerns that NHS recruitment restrictions were preventing qualified professionals from entering maternity services at a time when hospitals were reporting shortages.
This contradiction remains relevant to the current debate.
A shortage of maternity professionals does not necessarily mean suitable funded vacancies are available in every hospital.
Recruitment budgets, workforce planning, geographical demand and the availability of specialist posts can all influence whether qualified employees are able to find suitable work.
Improving the connection between training, recruitment and workforce demand will therefore be essential if maternity services are to become more sustainable.
Midwives warn that closing units could worsen existing pressures
The Royal College of Midwives has challenged suggestions that closing smaller maternity units would provide the best solution.
The organisation argues that years of insufficient investment have contributed to staffing shortages and difficulties maintaining local services.
It has warned that closures could increase travelling distances for expectant mothers while requiring some midwives to work further from their existing workplaces.
These concerns are particularly significant in rural and coastal communities where alternative maternity facilities may be some distance away.
The organisation is calling for additional investment in staffing, hospital facilities and sustainable maternity services.
Its response highlights an important distinction between identifying workforce shortages and deciding how those shortages should be addressed.
Although healthcare leaders agree that safe staffing is essential, they do not all agree that consolidating services is the appropriate response.
North Devon maternity suspension demonstrates recruitment difficulties
The staffing problems are already affecting some local services.
North Devon District Hospital temporarily suspended its consultant-led maternity service after difficulties maintaining sufficient senior medical cover.
The situation has increased concerns about the sustainability of smaller maternity units and the consequences for employees and patients when services cannot maintain appropriate staffing.
The suspension demonstrates how recruitment problems can affect healthcare delivery even before any wider restructuring programme is introduced.
For NHS workers, such developments can create uncertainty about future working locations, responsibilities and shift arrangements.
They may also increase pressure on staff at neighbouring hospitals receiving additional patients.
The North Devon situation is a specific local service disruption, not confirmation that the proposed 20-unit national closure estimate has been adopted.
New NHS staff standards aim to improve working conditions
The current debate also follows efforts to improve employment conditions throughout the health service.
Earlier this year, we reported on the introduction of new workplace standards in NHS staff working conditions standards launched: New rules to improve work life.
The framework focuses on safer workplaces, improved management, stronger protection against harassment and discrimination, and better support for employees.
These objectives are particularly relevant to maternity services, where staff retention and workplace culture are important considerations.
Healthcare employees working in demanding environments need appropriate staffing, adequate rest, effective supervision and opportunities for professional development.
Improving working conditions may help the NHS retain experienced employees while making healthcare careers more attractive to new recruits.
What could maternity restructuring mean for NHS workers?
Although no national closure programme has been approved, employees working in maternity services may understandably be concerned about the potential consequences of future changes.
If individual hospitals were to consolidate or reorganise services, workers could face changes to their normal workplace, shift arrangements, travelling requirements or responsibilities.
Depending on the circumstances, employment contracts and organisational arrangements may need to be reviewed.
Employers should consult affected employees appropriately and follow relevant employment procedures when proposing significant changes.
The Acas guidance on changing employment contracts explains the importance of consultation and agreement when contractual terms are being altered.
Employees seeking information about workplace restructuring, redundancy concerns or changes to working arrangements can also access The Workers Union workplace help section.
Importantly, a proposal to reorganise a maternity service does not automatically mean that the employees working there will lose their jobs.
In some circumstances, staff may be offered alternative roles or opportunities at other NHS facilities.
Government preparing national maternity action plan
The Government is expected to publish a national maternity and neonatal action plan in December 2026.
The programme is intended to address safety concerns and the wider challenges facing maternity services.
According to the latest reporting on maternity reform, the Government has highlighted investment in maternity safety improvements, alongside plans for a statutory maternity and neonatal commissioner and the extension of Martha’s Rule to maternity and neonatal settings.
These measures form part of wider efforts to improve patient safety and accountability.
However, the future configuration of maternity services remains under discussion.
Any proposals affecting individual hospitals will require detailed consideration of staffing, patient safety, accessibility and local circumstances.
NHS maternity workers need investment and certainty
The latest warning concerning up to 20 maternity units highlights the considerable challenges facing England’s maternity workforce.
Hospitals must respond to changing clinical demands while maintaining sufficient numbers of experienced professionals.
At the same time, employees need confidence that their working conditions, professional development and employment security are being properly considered.
There is evidence that concentrating specialist resources can benefit some services, but professional organisations have also highlighted the risks of reducing local access and placing additional demands on existing staff.
For maternity employees, the priority is clarity about future plans and meaningful involvement in any changes affecting their workplaces.
Recruitment, retention and investment in facilities will remain essential regardless of how services are organised.
The future of NHS maternity care must be built around safe services and a properly supported workforce. Whether hospitals retain their existing arrangements or undergo restructuring, the experience, skills and wellbeing of the employees delivering maternity care must remain central to every decision.
