Pregnant women and sick children are less likely to be treated by hospital doctors under plans announced by the Government. Instead, more support will be provided for community-based care, such as home births supervised by midwives, Sheila Shribman, the National Clinical Director for Children, said.

Patients might have to travel farther to see a doctor at a specialist centre, but would be treated better at home, Dr Shribman added.

However, the prospect of hospitals losing services has already sparked public anger. Demonstrations across England have involved Labour ministers and MPs.

Dr Shribman said that the redesign of services would lead to more choice and safer care for mothers and babies, and would not merely involve cutting costs. She insisted that there was no “national blueprint” for how services would be altered, and refused to say how many hospital wards might close.

European Union restrictions on working hours have made it impossible for specialist services to be provided at every local hospital, Dr Shribman said. This dictated that the best doctors should be on hand around the clock at regional centres.

“I do not believe the changes I am proposing are about the budget,” she said. “I understand people feel anxious when they think they might lose something. Women will not be losing access to a consultant should they need one. [They] might not be just down the road, there might be midwifery care down the road.”

The Government has promised women a choice of where they give birth by 2009. But the Royal College of Midwives (RCM) says that another 10,000 midwives would be needed on top of the 24,000 already in England.

Dr Shribman refused to be drawn on how many regional centres would be needed, but the Conservatives have claimed that 43 maternity units are at risk of cuts or closure — a fifth of the total.

Several government members, such as Hazel Blears, the Labour Party chairwoman, Jac-qui Smith, the Chief Whip, and Ivan Lewis, a Health Minister, have campaigned against cuts in their constituencies. In a Commons debate last month, Mr Lewis denied he was a hypocrite for opposing the closure of maternity services at Fairfield Hospital in Bury, Greater Man-chester. The MP for Bury South, who is responsible for maternity services at the Department of Health, said: “True hypocrisy would have been ditching that view on the day I became Health Minister.”

In another report published yesterday, Dr Shribman said that larger regional centres could also care for sick children better than more numerous smaller units. The report said that providing care “does not mean we need paediatric intensive care or inpatient facilities in every hospital”.

Andrew Lansley, Tory health spokesman, said: “Government seems to be saying that everything has got to change and smaller units have got to be shut down, while locally, Labour ministers say they don’t believe it and it’s not justified. There’s a hypocrisy in that.”

Dame Karlene Davies, the general secretary of the RCM, said that real choice was good news for women. But, she added: “We need more than fine words to ensure that this vision is translated into maternity services that provide not only choice but one-to-one care from the same midwife throughout pregnancy.”

Mary Newburn, of the National Childbirth Trust, said: “Just because services have been organised around hospitals doesn’t mean this is the best or only way of care.”

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