Maternity Outcomes Signal System (MOSS) transparency notice

The loss of a baby before, during, or shortly after birth, or a serious injury to a baby's brain is a devastating tragedy. The Maternity Outcomes Signal System (MOSS) is an NHS England tool that helps to alerts staff to potential maternity-related safety issues as early as possible. This transparency notice explains for the Maternity Outcomes Signal System (MOSS):

• why we collect information about people (we call this 'personal data')
• how we use this information, including who we share it with
• how long we keep it and where we store it
• the legal reasons for using it
• your data protection rights

To find out more about how NHS England uses personal information to improve health and care services, see NHS England Privacy Notice.

If you or someone close to you needs support, you can reach out to the UK's leading baby loss, neonatal care and brain injury charities which offer dedicated resources and safe spaces to talk:

Sands: The UK's leading stillbirth and neonatal death charity. 

Child Bereavement UK: Supports families and educates professionals when a baby or child dies, providing specialized support groups and resources. 

Bliss: A leading UK charity for babies born needing neonatal care.

Peeps HIE: Supports families affected by Hypoxic-Ischaemic Encephalopathy (HIE), which is a common type of brain injury caused by a lack of oxygen at birth.

Tommy’s: The UK’s leading pregnancy research charity.

NHS England is not responsible for the above websites, services or advice.

MOSS is an NHS England tool that helps maternity services spot unusual increases ('signals') in certain serious outcomes, so they can check for safety issues rapidly.

MOSS uses information submitted by NHS trusts to the Submit a Perinatal Event Notification (SPEN) service.

Access to MOSS is restricted to NHS staff who need it for maternity and neonatal safety oversight. We do not provide detailed information (raw data) about individuals through MOSS. 

We store the data securely in the UK.

Personal data: information that can identify someone (like an NHS number or date of birth).

Pseudonymised: the identifying details have been replaced, so it’s harder to  work out who the information relates to.

Signal: an alert that the rate of outcomes is higher than would normally be expected at a given maternity site.

Controller: the organisation that decides how and why personal data is used.

Legal basis: the legal reason an organisation is allowed to use personal data.

Aim

The Maternity Outcomes Signal System (MOSS) was developed by NHS England in response to the Reading the signals report (also known as the East Kent report). 
MOSS shows trends in serious outcomes for term babies in NHS trust maternity units in England and creates a 'signal' when there is an unexpected increase. A signal does not necessarily mean that a service is unsafe or that anyone was at fault – it prompts a rapid local safety check to identify issues for timely action. 

Escalation of safety issues is overseen by the Perinatal Quality Oversight Model and involves NHS England regional and national teams. MOSS is one part of NHS England’s wider work to improve maternity and newborn safety.

MOSS uses 3 key outcomes at term (from 37 weeks of pregnancy):

Stillbirth at term – when a baby tragically dies before or during labour after reaching term.

Death of a term newborn baby within 28 days – when a baby is born alive at term but tragically dies within the first 4 weeks of life.

Moderate (grade 2) to severe (grade 3) brain injury to a term newborn baby caused by lack of oxygen (Hypoxic Ischaemic Encephalopathy or HIE) – when a baby’s brain is tragically damaged because the baby did not receive enough oxygen or blood flow around the time of birth.  

Reducing stillbirths, newborn baby deaths and serious brain injuries in babies is a key national priority for the NHS. NHS England tracks these outcomes to inform national policy and help improve newborn safety.

Preventing the tragedy of maternal death is also a key national priority for the NHS. Information about maternal deaths is tracked by NHS England to inform policy and improvement work. This data will not be used in the MOSS tool.

NHS England is the data controller for MOSS. This means NHS England decides what personal data is needed for MOSS and how it is used.

The personal information we collect includes:

• baby’s NHS number
• baby’s date of birth
• baby’s date of death

We also collect details about the event and the birth, for example:

• where the birth and, if relevant, the baby’s death happened
• the type of event it was, for example, a stillbirth, a newborn death, or moderate to severe brain injury (HIE)
• dates linked to the event, such as the incident date
• information about the birth, such as gestational age and birth weight
• some clinical information used to understand the event, for example, whether therapeutic cooling was used

We also collect some Information about maternal death, including:

• mother's date of death
• whether the mother went into labour before she died
• whether the mother’s death was connected to childbirth. or something else

NHS England collects this information from NHS trusts.

We use this information to create signals in MOSS using a proven statistical method you can read about in the MOSS standard operating procedures. 

MOSS information is updated every day. It shows trends for each hospital-based NHS trust maternity unit. It shows outcomes and the baby’s date of birth, which helps support rapid local safety checks following signals. 

MOSS also shows summary information of the numbers of signals generated and where these occurred at regional and national level to support safety reporting.

We may also use this information, together with other pseudonymised information held by NHS England, to inform national policy and improvement work.

We are only allowed to use personal data if the law says we can. This section explains the legal reasons NHS England can use information for MOSS.

NHS England collects and analyses maternity safety information for MOSS under a legal direction called the Outcomes and Registries Directions 2024.

The specific information needed for MOSS is set out in the MOSS data requirements specification. 

Legal obligation (UK GDPR Article 6(1)(c)): we use the information because the law requires us to.

Substantial public interest (UK GDPR Article 9(2)(g)): some of the information is sensitive health information, and the law allows us to use it for important public interest reasons. This is supported by Data Protection 2018 Schedule 1, Part 2, paragraph 6 - statutory and government purposes.

Access to MOSS is approved centrally in NHS England and is only available to NHS staff who support, deliver or are accountable for the quality of maternity and neonatal services. 

MOSS does not provide downloadable raw data. NHS England may publish reports on its website about signals and whether services identified any safety issues through local checks. These reports will not include information that identifies individuals.

We will keep your information for 20 years in line with the NHS Records Management Code of Practice.

We securely store information on our servers in the United Kingdom (UK).

NHS England is the data controller for the information we hold about people for MOSS. This means we are responsible for deciding how and why that information is used. Your data protection rights, including the right to access your information, are explained in the NHS England privacy notice.

Further detail on personal data rights can be found on the Information Commissioner’s Office (ICO) website.

To make a rights request, email us at [email protected].

We take protecting personal information seriously. If you have questions or concerns about how NHS England uses personal information, you can contact our Data Protection Officer: [email protected].

If you are not happy with our response, you have the right to complain about how we use information. You can contact the Information Commissioner’s Office by calling 0303 123 1113 or through their website.

We may update this notice. If we do, the 'last edited' date will change. Updates apply from the date they are published.