Roundtables on maternity and neonatal service change after Amos
tCI is running three linked 45-minute roundtables for senior leaders in trusts and integrated care boards who take maternity service decisions or lead the involvement of women and families. They run under the Chatham House Rule and end with an NHS practice briefing that separates settled requirements from open questions. Places are limited: complete the registration form or email hello@consultationinstitute.org.
The Amos investigation reported on 30 June 2026 and the maternity and neonatal action plan is due in December. The BBC and the Guardian have since reported NHS managers’ view that some smaller units may have to close. Trusts and integrated care boards will face questions about their own units before they have any proposal to put to women and families.
What did the Amos investigation find?
The Independent National Maternity and Neonatal Investigation, led by Baroness Amos, found that maternity and neonatal care in England is no longer fit to deliver high-quality, compassionate care consistently. Women were too often not listened to, and racism and discrimination drove inequalities in care. Services were slow to respond to safety concerns and changing demand, and the parts of the pathway were not joined up.
The report makes eight recommendations, one of them a Modern Service Framework of national standards covering triage, workforce models and service design. The Government has set up a National Maternity and Neonatal Taskforce. Its national action plan, which will draw on Amos and the independent review of maternity services in Nottingham, is due in December 2026.
Some national requirements already apply. NHS England published a national maternity triage specification in July. Its assurance process for the Maternity and Neonatal 10 Point Plan asks trust boards to approve returns due by 25 September and 31 December 2026. The Government had published no decision on the framework by early October.
Why will families ask about their own unit before any proposal?
On 19 October the BBC and the Guardian reported the view of the NHS Alliance, which represents health service managers, that some smaller maternity units may have to close. The Guardian reported the Alliance’s estimate that up to 20 of England’s 155 consultant-led units could close or change their role, with units delivering 1,500 to 2,000 births a year the most exposed. The estimate is the Alliance’s own and is not national policy.
Some units already run differently. Royal Devon University Healthcare NHS Foundation Trust suspended births at North Devon District Hospital in Barnstaple from 11 August because of staffing levels. The trust describes the suspension as temporary and says it will reopen once staffing and rotas are assured. North Devon Council called a special meeting over it.
Where a service already runs under a temporary change made for safety reasons, the coverage leads women, families and staff to one question: will the change become permanent? The answers leaders give now, before there is a case for change or anything to consult on, will shape whether women and families trust any later proposal. Leaders cannot answer for national standards that do not yet exist, and silence lets the national coverage answer for them.
Does a national standard decide the future of a local unit?
No. National safety requirements may narrow the configurations that clinical evidence can support, but they do not decide the future of an individual site. The statutory duties for NHS service change still apply: the duty to involve the public, the duty to consult the local authority on substantial change, the public sector equality duty and the health inequalities duties.
The duty to involve is in section 242 of the NHS Act 2006 for trusts and section 14Z45 for integrated care boards (ICBs), the NHS bodies that plan and fund local services. Consultation with the local authority runs through health scrutiny, usually the council’s Health Overview and Scrutiny Committee (HOSC). The public sector equality duty (PSED), in section 149 of the Equality Act 2010, requires due regard to the effect of a decision on people with protected characteristics. In tCI’s experience, challengers look at the equality analysis first, and the Amos findings on racism and discrimination will make a thin analysis harder to defend.
The courts accept that some options can be ruled out before consultation. In R (Nettleship) v NHS South Tyneside CCG [2020] EWCA Civ 46 the Court of Appeal held that commissioners need not consult on options they had judged unviable. The case included maternity services in South Tyneside and Sunderland. The recorded reasons for ruling an option out, with the evidence behind them, therefore become part of the legal defence.
Temporary changes follow their own rule. Where safety requires an urgent change, the local authority must be told as soon as possible but need not be consulted first. If the change is later proposed as permanent, the full process applies, and the service does not have to be restored before that process starts.
The risk is greatest at the boundary between national requirement and local judgement. Present an option as open when a national standard has removed it, and women and families are offered a choice that does not exist. Rule an option out on national grounds the standard does not support, and they lose a choice they should have had. Both errors damage trust, and the second is the one most likely to be challenged. Until the Modern Service Framework is settled, that boundary will keep moving.
How tCI can help
tCI is running three linked roundtables for senior leaders in trusts and ICBs who take maternity service decisions or lead the involvement of women and families. Session one, held before the action plan is published, asks what boards and executive teams should have ready for the new year. Session two asks when a national requirement rules out a local option and how to explain that to women and families with the evidence behind it. Session three, held as the detail of national standards emerges, looks at how proposals can stay formative, meaning still open to influence, while national policy moves.
Each roundtable lasts 45 minutes and runs under the Chatham House Rule, so what is said can be used but not attributed. Participants receive a short note after the first two sessions and, at the end, an NHS practice briefing that separates settled requirements from open questions. The discussions do not replace the involvement of women and families in local decisions, and no decision about any service is taken in them.
Places are limited and reserved for those who take decisions on maternity and neonatal services. To register, complete the registration form or email hello@consultationinstitute.org.
Where a programme already faces these questions on a live decision, tCI’s Advice and Guidance service can support it. If this is becoming difficult in your context, tCI can help.