NHS leaders need air cover for “inevitable difficult decisions” on maternity services

NHS leaders are calling for political air-cover for “inevitable” decisions ahead on closing and consolidating maternity services, in order to protect patient safety.

The NHS Alliance, which speaks for organisations across the health and care system says the current configuration of maternity care across England is not fit for purpose, with particular pressures on smaller units in rural and coastal areas. 

It says a marked increase in medical interventions in birth has compounded these challenges, as services increasingly struggle to ensure adequate staffing and availability of operating theatres and beds in outdated, decaying buildings. As a result, it says, the risk to safety in these organisations is a daily challenge.

The call comes as the National Maternity and Neonatal Taskforce is preparing an action plan in response to recent public inquiries highlighting failings in maternity services.

Drawing on consistent feedback from local NHS leaders across England, the NHS Alliance says the taskforce must “grasp the nettle” by tackling the strategic issues underpinning the challenges services face, including the rise in C-sections, increasing levels of complexity, which requires changes in the clinical model of care, and the staff skill-mix required to deliver safe services. 

It is also calling for a thorough appraisal of where maternity services should be located, with a recognition that some smaller units, typically those delivering between 1500-2000 babies a year, might need to close.

The viability of smaller units is not only a question of birth numbers or midwifery staffing. It also depends on maintaining sufficient consultant obstetric, anaesthetic and neonatal capacity, including the availability of specialist staff and sustainable on-call rotas, alongside wider hospital support services.

The NHS Alliance says difficult decisions are inevitable in the interests of patient safety and to address deep-rooted inequalities, including significantly worse outcomes in deprived communities and raised maternity mortality rates for Black and Asian women.

Local leaders are clear they will need local and national political support as they engage with their communities about how best to organise their maternity services. These discussions must involve NHS leaders, clinical staff, patients and local populations. Politicians too have a key contribution to make – requiring courage to stand up for patient safety.

The director of the NHS Alliance’s acute and ambulance network, Matthew Hopkins, said:

"The way maternity care is delivered has moved on.

"A key driver for change is the rise in C-section deliveries and the effect this is having on capacity and staffing, especially in smaller maternity units.

"The recent problems in Devon were not a one-off. The risk to safety in these organisations is a real challenge.

"Difficult decisions lie ahead, consolidating maternity services to support safer, more sustainable care.

"Local plans must involve NHS leaders, clinical staff, patients and communities.

"Local and national politicians have a key role to play. They must have the courage to make the case for patient safety, offering air cover for change.

"We know this can be done. But it is difficult, and local NHS leaders need that support.

"It is time now to take a step back and consider how we should best organise maternity services across England, and where those services should be located.

"It is vital that the forthcoming maternity and neo-natal action plan looks beyond tokenistic measures to address these key strategic concerns."