Why are some NHS maternity units facing closure?

The NHS needs to cut the number of hospitals providing maternity services in England to help keep patients safe, a health service leader who has run four different NHS trusts has said. Speaking to the Guardian, Matthew Hopkins, the NHS Alliance’s lead director for acute care, recognised that such changes would be controversial and unpopular, mainly affecting hospitals in rural and coastal areas and forcing pregnant women to travel further to give birth.

These hospitals often struggle more than those in cities to recruit enough doctors and midwives. So what is Hopkins proposing, why is he doing so now, and what impact might his views have? Who is Matthew Hopkins? He is the lead for acute care at the NHS Alliance, which represents many of the different organisations in England’s health service, including most NHS care providers (trusts).

He previously ran four big acute trusts: in Epsom and St Helier in Surrey; Barking, Havering and Redbridge in east London; Worcestershire; and, until last year, Mid and South Essex. Why has he spoken about this now? The government’s maternity and neonatal care taskforce is preparing to publish a major report before Christmas setting out its recommendations on how to end the widely recognised crisis in NHS maternity services in England.

It will form the basis of a maternity action plan that Yvette Cooper, the health secretary, will announce. But Hopkins told the Guardian that NHS trust bosses fear the plan may shy away from confronting what he says is the need to close some of England’s 155 consultant-led maternity units to improve patient safety, because of the “political backlash” such proposals would inevitably generate.

The NHS Alliance is “concerned that the report … will be tokenistic [and] won’t deal with the real strategic issues that underpin the problems”, he said. It needs to set out how the NHS should deal with the recent sharp rise in caesarean births, outline “a refreshed approach to the clinical model for maternity services” – which hospitals should provide which types of care – and explain what that rethink would mean for “some of our smaller units that are struggling to staff safely from an obstetrician hours perspective”.

Such units are often short of consultant obstetricians. What did Hopkins say about closing maternity units? He explained his belief that an NHS-wide lack of obstetricians and the rapid growth of C-section births mean some consultant-led maternity units will have to close.

These would be units handling only 1,500 to 2,000 births a year, mainly in rural and coastal areas. “It’s inevitable” that some of those may need to shut because understaffing means they cannot provide safe care around the clock. In August, the Health Service Journal estimated that 24 such units could be at risk of closure if ministers and NHS bosses accept Hopkins’s view that they are becoming unsustainable.

Asked if he agreed with that estimate, he cited a figure of 20 for the number of places where centralisation of services may be needed. One of the HSJ’s 24 units – at Barnstaple in north Devon – shut temporarily in August. Another, at the Royal Free in London, is due to shut permanently, with nearby hospitals, including the Whittington, expanding their maternity facilities to accommodate more births.

That change is closely linked to the falling birthrate in the Royal Free’s catchment area, rather than staffing problems affecting other units. Does consolidating maternity care into fewer places improve outcomes? Hopkins said two of the trusts he used to run – in east London and Worcestershire – had both previously combined childbirth care from two sites into one.

“In both situations outcomes for mums and babies improved.” Centralisation helped the Worcestershire trust earn a “good” rating for its maternity service from the Care Quality Commission, the NHS watchdog, he added. “So there are examples of where there were difficult decisions that were taken that led to improved and safer delivery of care.” The taskforce must “use the evidence from those examples, through this report, to signal the need for consideration of a set of different clinical models and, in some cases, consolidation of services”.

Its report will show if it has taken on board Hopkins’s views, which he said are widely shared in the NHS, especially among the bosses of smaller hospitals facing the maternity challenges he set out.