Exclusive: Up to 20% of England’s 147 consultant-led units need to close due to doctor shortage, says obstetricians’ leader

Up to one in five hospital maternity units where consultants supervise births needs to close in order to ensure mothers in labour receive better care, the leader of Britain’s obstetricians and gynaecologists has said.

Between 10% and 20% of obstetric units across England should go because serious shortages of maternity doctors means dangerously stretched staff spend too little time with mothers-to-be, whose care may then suffer, Dr David Richmond told the Guardian in an interview.

Acknowledging that his controversial proposal would create “a public and political furore”, the president of the Royal College of Obstetricians and Gynaecologists (RCOG) said there should be a big expansion in the number of midwife-led units so women could still choose where to give birth.

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If adopted, Richmond’s advice would see the number of consultant-led maternity units shrink from 147 to as few as 118, creating what some critics call overly large “baby factories”.

“I think we need a public debate about the sustainability of the service as we know it, matching patient expectations with the desires to improve the quality and safety of the pregnant mums we deal with. Are there enough obstetric doctors? In practice, no, to run all obstetric units in the country.

“We may need to consider the configuration of units which traditionally have had medical staff. If we work with the numbers of bodies that we’ve got at the moment it makes common sense to maximise your expertise ... in a smaller number of units. But I suspect that’s probably only reducing them by 10%, maybe 20% in total,” Richmond said.

Facebook Twitter Pinterest Dr David Richmond. Photograph: Linda Nylind/The Guardian

“There is an opportunity to focus the number of delivery units where you need medical expertise, or you think might need expertise, in a smaller number of premises. The medics are stretched too thinly and I think the clinical quality of care could be better [as a result of centralisation]. The impact of that is that you’re not providing optimum care.”

Quality of care was hampered by a shortage of 25% to 30% of middle-grade maternity doctors, those who are halfway between being junior medics and consultants, he said. That had produced “a rota gap problem nationally” which forced consultants to work extra hours to plug the gaps.

The medical benefits that followed the centralisation of stroke and trauma care into fewer hospitals in England showed that patients benefited medically from life-or-death care being centralised, Richmond said, and that should now be applied to childbirth. Reducing the number of maternity units in Greater Manchester in the 2000s from 13 to eight also showed that, while controversial, it was better for mothers and babies.

NHS maternity services could be reorganised into 12 regional networks, each one of which would cut their number of obstetric units “by one or two”, he said. Geography, however, should be strongly factored into plans for change, with areas such as Cumbria protected.

The recent baby boom, and especially the increased complications of childbirth resulting from the trend towards older motherhood and a doubling in the number of obese mothers from 5% to 10%, as well as the shortage of maternity medics, meant change was needed, Richmond said.

Centralisation would mean that more hospitals could have a consultant on duty 24/7, or close to it, in their maternity unit, which otherwise would not be possible.

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Boosting the number of units run by midwives, which deal with normal, low-risk births, should happen alongside changes to consultant-led obstetric units, Richmond said. England currently has 101 midwife-led units situated next to hospitals, in case a mother needs emergency care such as a caesarean section or experiences a complication such as a tear. There are also 55 standalone midwife-led units which are not based at hospitals.

Dr Daniel Poulter, a Conservative MP who was the health minister responsible for maternity services under the coalition, defended Richmond’s recommendation as the best thing to do to protect patient safety and to counter “burnout” among obstetric doctors.

“Obstetrics is a very rewarding speciality, and it is a fantastic experience to bring a new life into the world. But the heavy toll of nights, shifts involving antisocial hours and increasing litigation has made burnout amongst middle-grade maternity doctors more and more common, and many now make the difficult choice to leave the speciality”, said Poulter, who worked as a middle grade doctor in obstetrics and gynaecology at a London hospital while he was a minister.

“As the safety of women and their babies is a maternity doctor’s first priority, then David Richmond is making the only recommendation that he can do to ensure patient safety.”

Hospitals that lose their consultant-led obstetric unit would then also be at risk of losing related medical services, such as paediatrics and A&E, Poulter warned. “So the consequences of a shortage of middle grade maternity doctors may have far-reaching ramifications for other hospital services,” he said.

The parenting charity National Childbirth Trust said centralisation would force some women to travel much further than at present to have their baby.

Elizabeth Duff, its senior policy adviser, said: “We’d like to see a UK-wide obstetric service where care can be provided without pregnant women having to travel long distances, which can be uncomfortable and possibly dangerous for them. While it’s understood that monitoring and treatment for exceptional conditions may be only available in a few centres, women in more rural or remote areas should be able to access most obstetric care locally with doctors who can call on expert support if needed.”

Cathy Warwick, the chief executive of the Royal College of Midwives, also voiced concern that very large units could mean a poorer experience for mothers. She said: “The RCM is concerned that the centralising of maternity units could result in hospitals delivering more than 10,000 babies a year.

“These maternity units are problematic because their size makes them difficult to provide personalised high quality and we hear from midwives that they are not always not attractive places to work.”

A Department of Health spokesman said: “We want the NHS to be one of the safest places in the world to have a baby and there are already more than 5,500 obstetricians and gynaecologists in the NHS. This includes over 2,000 consultants, an increase of 20% since 2010.”