One in five maternity services in England—mainly in London—are failing to provide adequate quality of care and will have to produce action plans for improvement, warns a comprehensive review of maternity services published last week.

Some obstetricians countered that lack of a central information system and clearly defined quality indicators had prevented maternity services from being able to report data on clinical care requested by the review, resulting in their being labelled as “under-performing, despite other indicators demonstrating high quality care.”

The Healthcare Commission, the watchdog that monitors quality of care in the NHS, carried out the assessment after concerns that this area of care currently accounts for one in every 14 of cases referred on safety grounds to its investigation unit.

The review set performance benchmarks for maternity for the first time. It assessed all 148 trusts that provide maternity services in England in three main areas: clinical focus, woman centred care, and efficiency and capability. It used 25 indicators that had been identified as important by guidelines, clinicians, and a survey of women. These included the type of scans offered to women, staffing levels, women’s assessment of the cleanliness of …