Mothers and babies in England will receive safer care as NHS England rolls out a national safety signal system across all maternity services.
The Maternity Outcomes Signal System (MOSS) rapidly analyses routinely recorded maternity data to detect patterns or trends that may indicate emerging safety issues. When an unusual pattern is identified, MOSS sends a warning signal prompting an urgent safety check on that unit. Once a signal is generated, the maternity unit must carry out a critical safety check within eight working days and share actions with regional and national teams.
Signals are traffic-light coded: amber alerts indicate 95% confidence and red alerts 99% confidence that an increase in events is real and needs urgent attention. The system operates seven days a week and displays data and signals at trust, Integrated Care Board (ICB), regional and national levels, ensuring visibility from ward to board. National health chiefs have instructed hospital executives to raise MOSS-identified safety issues at public board meetings.
Retrospective analysis suggests MOSS would have detected signals in units that later experienced serious incidents, including East Kent, Shrewsbury & Telford, Leeds, and Nottingham. The tool aims to encourage a positive safety culture in maternity services by helping staff identify and address concerns openly and promptly.
Duncan Burton, Chief Nursing Officer for England, said the system will help avert safety incidents and prevent tragedies by spotting early warning signs in near real-time. He emphasised that it will be the responsibility of maternity staff and hospital executives to act urgently on warnings so problems cannot be ignored or delayed.
Cambridge University Hospitals NHS Foundation Trust was among the first pilots. Cathy Bevens, lead safety and governance midwife there, said: “We have had really positive experiences using the signal system – colleagues feel like we are being responsive. The system and safety check brings us together as a team and makes us really focus on what the issues are and where care can improve. It’s encouraged senior leaders and executives to come and talk to staff and service users, to listen to their issues and concerns. This has prompted a building of trust and teamwork, and acknowledgement of the lived experiences of women on the labour ward.”
MOSS was created in direct response to a recommendation in the “Reading the Signals” report, following the independent investigation into East Kent maternity and neonatal services led by Dr Bill Kirkup. An expert group that developed MOSS included Dr Kirkup, Professor David Spiegelhalter (a leading authority on statistical risk), families and service users. Dr Kirkup said the development was a positive outcome from the East Kent investigation and credited families who brought the issues to light.
Chris Binnie, a national service user representative whose son was stillborn in 2014 due to undetected intrauterine growth restriction, said MOSS fosters “a culture of curiosity” that enables learning and change and can help prevent avoidable stillbirths and neonatal deaths.
MOSS applies cumulative sum control chart methodology—already used in children’s cardiac services and paediatric intensive care—to maternity, focusing specifically on intrapartum care safety. This statistical approach helps detect trends in rare but serious events so that action can be taken sooner.
Health and Social Care Secretary Wes Streeting said the system is a key step to improving maternity care and that every signal will be visible from ward to boardroom and investigated. He announced a maternity and neonatal taskforce and a rapid national investigation process to support long-lasting change across the country.
Clea Harmer added that early detection of serious safety issues is vital to saving babies’ lives and welcomed the rollout as an important step in implementing recommendations from Reading the Signals. The launch of MOSS forms part of NHS England’s broader support for maternity and neonatal care improvements, including programmes such as the Perinatal Equity and Anti-Discrimination Programme.