As have stated did not find that the evidence established a causal or contributory connection between the unregulated placement and Jacob's death: found this to be So on the applicable civil iaw test; the balance of probabilities. However in my summing-up did express my serious concerns that Jacob had been placed in an unregulated placement despite his history, needs, and risks_ Evidence was given at the inquest hearing by two former employees at the placement that had no prior experience of working with young people (indeed no experience . of working in any form of care-related work) and were left in charge of the unit where Jacob was placed after a very short period of commencing employment (one former staff member said that he had only completed two shadowing sessions before being asked to be in sole charge of the unit overnight). The evidence of the responsible local authority was that it had not sought evidence from the placement provider as to staff competency and training, or that suitable policies and procedures were in place; it" effectively accepted the assurances of the provider prior they

The local authority stated that it now has systems providing for greater scrutiny and diligence but it was explained that where residentiallsupported provision is solely for young people aged 16 to 18 that provision: falls outside or the statutory regime of inspection , and regulatory compliance as enforced by Ofsted. My understanding is that the issue of unregulated placements for 16 to 18 year olds has been widely highlighted as a cause for concern but the evidence of a senior local authority manager at inquest was that she was unaware of any plans nationally to address the issue despite concerns having been very widely raised. 1. Vulnerable young people, aged 16 to 18 , are being placed in unregulated placements_ Any young person under the age of 18 placed in an unregulated placement is likely to have very significant vulnerabilities, and it is Iikely that young people with complex needs and at significant risk are being placed in such placements; indeed this was the case for Jacob_ 3_ As the placements are unregulated there are no statutory regulations to comply with relating to competency and appropriate policies and procedures by the provider and there is no regulatory body to check and assess those providers_ This is clearly a concerning situation given the very high level needs that some of the young people will have The lack of statutory regulation then places an onus on local authorities to check that a provider is competent and safe_ Whilst in making individual placements it must be the duty of a local authority to satisfy itself as best as it is able that placements are 'safe' , given the pressures on local authorities it cannot be the case that are in a position to mirror the type and nature of inspection arid oversight that might be provided by regulator such as Ofsted .
5. In view of the points made above the lack of statutory regulation is placing vulnerable young people at risk, and:' there is a realistic possibility that deaths may occur