Maternity unit level

1. A MOSS signal occurs at a trust site.
2. An automatic email notification is immediately sent to all registered trust, ICB and regional MOSS users within the parent geographical footprint of the trust site that signalled.
3. The perinatal leadership team completes the MOSS critical safety check within 8 working days (if a signal is received over the weekend, the timeline begins on the next working day). By the end of this, they must:
   1. [in level 2 signals only] have shared the completed check with an external peer for check and challenge (for example, maternity improvement advisor if trust is enrolled onto the Maternity Safety Support Programme, or an ICB or regional colleague with a remit over perinatal quality)
   2. [in all signals] have the completed check approved by an accountable trust board executive (that is: chief nurse, chief medical officer or executive trust board safety champion)
4. (a) If the MOSS critical safety check does not identify any safety issues, the perinatal leadership team shares the completed and approved check with ICB (ICB executive with responsibility for maternity and neonatal services and director of quality) and regional colleagues (regional chief nurse, midwife, obstetrician, medical director and their deputies) for awareness only.
   (b) If the MOSS critical safety check does identify safety issues, the perinatal leadership team shares the completed and approved check with ICB colleagues for oversight and regions for awareness, or regional colleagues only if oversight responsibilities have been transferred (see important note in section 4 of the standard operating procedures).

Trust board level

5. An accountable trust board executive should inform the trust board of safety issues found from critical safety checks, which should be discussed as an agenda item at the next public trust board meeting. Safety issues should be overseen by trust boards as recommended in the MOSS critical safety check.

ICB level

(Note: this level is not required if regions have transitioned to the Model Region Blueprint [NHS Futures login required] and no longer have oversight of performance management of services)

6. ICBs should provide oversight, support and escalation of safety issues identified from the MOSS critical safety check, until the transition to regional performance management oversight has happened. ICBs may escalate to regional colleagues as necessary.

Regional level

7. Regions should provide oversight, support and escalation of safety issues identified from the MOSS critical safety check, which should be discussed at the regional perinatal quality meetings. Regions may escalate to national colleagues as necessary.

National level

8. The national team should provide oversight and support of escalated safety issues, which should be discussed at National Perinatal Surveillance Group meetings.

Publication reference: PRN02098_vii