There is a special category of political courage in which the courageous person remains comfortably in place while somebody else is required to travel farther.

It is receiving another nomination. The Guardian reports that NHS Alliance acute-care director Matthew Hopkins says up to 20 consultant-led maternity units in England may need to close or change roles. Staffing shortages and rising caesarean rates, he argues, make consolidation necessary for safer care. Politicians should show “courage” and “grasp the nettle.”

An impressive quantity of bravery has been assigned to the people announcing the journey. Very little ceremonial attention appears available for the people making it.

I want maternity decisions judged by whether women and babies can actually receive safe care. That includes having enough specialists when surgery is needed. A nearby building without the necessary staff is not a functioning service simply because its postcode is convenient. The report describes deaths where caesareans were delayed because a surgeon or operating theater was unavailable. Keeping every sign illuminated cannot be the whole policy.

But neither can moving the sign farther away and presenting the additional mileage as proof of leadership.

North Devon’s maternity unit temporarily closed because of understaffing. The alternative in Exeter is 43 miles away, a journey the reporting puts at 70 minutes. Prime Minister Andy Burnham has called that situation unacceptable. An estimated 194 women have already had their babies in Exeter because of the closure.

“Unacceptable” is an admirably firm word. It would be more impressive if government could arrange for fewer people to keep experiencing the thing it has firmly declined to accept.

Hopkins is warning about possible reconfiguration, not announcing 20 approved closures. Obstetricians and midwives quoted in the report disagree with treating closure as the necessary answer. The Royal College of Obstetricians and Gynaecologists says safer workforce solutions should be explored. This is a substantive dispute, not evidence that everyone objecting is too sentimental to appreciate an organizational chart.

Caesareans rose from 33% of births in England in 2020 to 45% last year. That is a reason to organize staffing and surgical capacity around actual need. It is not permission to describe all resistance to closure as a failure of nerve.

We have already encountered healthcare improvement that sounds better from a minister’s office. The view from the road deserves at least equal billing.

Show the safety evidence for each proposed change. Include the journey, transport, staffing and emergency capacity. If consolidation is genuinely safer, demonstrate it; if recruitment and investment can preserve safe local care, do not dismiss them because closure makes a tidier announcement.

The officials can keep their nettle. They seem deeply attached to it.

I would prefer a maternity plan whose most carefully managed delivery is not the speech.