The King on the Application of Jada Bailey v HM Senior Coroner for East London

Hearing dates 13 February and 17 June 2025

Approved Judgment

This judgment was handed down remotely at 2 pm on 30 June 2025 by circulation to the parties or their representatives by e-mail and by release to the National Archives.

A. Introduction

Jada Bailey (“the Claimant”) challenges the decision of HM Senior Coroner for East London (“the Coroner”) not to resume the inquest into the death of her son, Jaden. In the serious case review report, prepared on behalf of the Safeguarding Children's Board for Waltham Forest, which was the subject of the bulk of the submissions in this case, Jaden was referred to as “C”. In this judgment, I refer extensively to that serious case review report so, for sake of consistency, I will also refer to Jaden as “C”. C died on 8 January 2019. He had been riding a moped in Leyton in East London and was hit by a car. Those inside the car then got out and stabbed him. He died at the scene. He was 14 years old.

The inquest into his death was formally opened on 18 January 2019. However, on 19 January 2019, Ayoub Majdouline was charged with C's murder. On 2 April 2019 the Coroner adjourned the inquest pending the criminal trial, a decision required by paragraph 2 of Schedule 1 to the Coroners and Justice Act 2009 (“the 2009 Act”). On 11 December 2019 Ayoub Majdouline was convicted of C's murder, and on 18 December 2019 he was sentenced to life imprisonment with a minimum term of 21 years.

On 24 December 2019 the Coroner issued a certificate that the inquest was not to be resumed. On 14 June 2023 the Claimant applied to the Coroner to resume the inquest. On 27 November 2023 written submissions, settled by counsel acting on behalf of the Claimant (who continues to act for her in these proceedings), were made in support of the application. The Coroner's decision not to resume the inquest is set out in a document dated 18 March 2024. The material part of that decision is as follows.

“28. I accept the family's submission that the State's investigative obligation under Article 2 ECHR was engaged on the basis of potential breach by the police of their operational duty to safeguard Jaden's life. The low threshold of arguability is made out here by the admitted failings of the MPS combined with the findings of the SCR.

29. I reject the argument that the investigatory obligation was engaged on the basis of potential breach by the police and other agencies of the systemic duty to safeguard Jaden's life. Such a duty operates at a high level, the “duty to put in place a legislative and administrative framework to protect the right to life, involving effective deterrence against threats to life, including criminal law provisions to deter the commission of offences, backed up by a law enforcement machinery for the prevention, suppression and sanctioning of breaches of such provisions” ( Van Colle v Chief Constable of the Hertfordshire Police [2009] 1 AC 225 at para 28. In this case numerous systems were in place during the material time. The argument that the systems in place can be assessed as insufficient due to the fatal outcome for Jaden is a syllogism.

30. I now turn to the question of whether the state has satisfied the enhanced procedural obligation under Article two? Here the question I must pose is whether all the other investigative procedures of the state have collectively satisfied the requirements of the procedural obligation (see Goodson v HM Coroner for Bedfordshire [2004] EWHC 2931 (Admin) at paragraph 59 (iv) and (vi)). I remind myself that it is necessary for the Coroner to consider “the totality of available procedures”, including public investigations and any potential for a civil claim: R(AP) v HM Coroner for Worcestershire [2011] EWHC 1453 (Admin), [95].

31. The decision of a Coroner on whether or not to resume an inquest has been described as one “of a highly discretionary character”. I remind myself of the guidance provided by the Chief Coroner in Law Sheet No.5 which asserts that the wide discretion a Coroner has in making decisions, “emanates from the inquisitorial nature of the coroner's inquiry.” ( R v South London Coroner, ex parte Thompson (1982) 126 SJ 625). There must be a good reason for me to exercise my discretion in a particular way, both in fact and in law. As Lord Greene MR said in the Wednesbury case “… a person entrusted with a discretion must, so to speak, direct himself properly in law. He must call his own attention to the matters which he is bound to consider. He must exclude from his consideration matters which are irrelevant.’.”

32. There is no prescriptive approach to the form of an Article 2 investigation and, although its precise constituents will vary from case to case, the minimum requirements were set out in Jordan v United Kingdom (24746/94) (2003) 37 EHRR 2, [2001] 5 WLUK 158.

33. I have considered and adopt the ratio of Garnham J in R (Sharon Grice) v Her Majesty's Senior Coroner of Brighton and Hove v The Chief Constable of Sussex Police, Sussex Partnership NHS Foundation Trust [2020] EWHC 3581 (Admin) [84–85].

a. No particular procedure had to be adopted in order to fulfil the Jordan requirements. The requirements can be satisfied by a set of separate investigations, rather than by a single, unified procedure.

b. The requirement for the family of the deceased to be involved in the investigation did not mean the investigating authorities had to satisfy every request for a particular step to be taken.

c. The requirement for public scrutiny did not invariably require a public hearing nor did it mean that the family had to be able directly to test the evidence.

d. There was no requirement that each element of the investigative procedure met each one of the tests.

34. I have sought and secured disclosure to allow me to properly assess the nature and scope of; the criminal trial, the SCR, the PCIR and the PCAR, having considered that material I find that the state has: acted of their own motion to investigate; the cumulative investigation process was independent, effective and reasonably prompt; the investigations did have a sufficient element of public scrutiny of its processes and results to secure accountability; and that there was involvement of the next of kin to the extent necessary to safeguard their legitimate interests. As such, I do find that the state fulfilled its obligation under the enhanced investigative obligation through the totality of the investigations set out above. In simple terms I pose myself the question, have the cumulative investigations covered the likely scope of an inquest and my answer is that that they have and indeed have gone beyond the remit of the type of inquest described by the Lord Chief Justice in R(Morahan) v HM Assistant Coroner for West London [2022] EWCA Civ 1410 “an inquisitorial and relatively summary process. It is not a surrogate public inquiry.”.

35. I go on to ask myself whether the conclusions of any inquest could provide valuable conclusions (primary conclusions and a Regulation 28 report) that would go beyond the conclusions reached in the other investigations? Firstly, the limitations placed upon me mean that any primary conclusion at inquest could not be inconsistent with the result of the criminal trial and therefore “Unlawful killing” would be the most appropriate conclusion.

36. Secondly, a Regulation 28 report is simply a report not a ruling, it is toothless to the extent that a coroner cannot proscribe a solution to the concern identified, require specific performance of remediation or even demand that the report is responded to. Other inquiries into Jaden's death have been able to make recommendations and require action.

37. I ask myself is this submission intended to lead to an inquest that would relitigate the criminal trial? I do not find that to be the case.

38. Finally, I ask myself what are the family wishes? There clear wish is that a Middleton inquest is heard into the death. I value their submissions and understand their depth of feeling but I note that the family wishes are not the determinative issue. I am not satisfied, for the reasons set out above, that there is sufficient reason to resume the inquest into Jaden's death pursuant to para 8(1) Sch 1 CJA 2009.”

The reference in paragraph 38 of the Coroner's reasons to paragraph 8(1) of Schedule 1 to the 2009 Act is to the provision that an investigation that has been suspended “… may not be resumed unless … the senior coroner thinks there is sufficient reason for resuming it”. The reference in his reasons to “the SCR” is to the serious case review commissioned by the Safeguarding Children's Board for Waltham Forest. That review was undertaken by John Drew. Mr Drew was Director of Social Services at the London Borough of Redbridge from 2000 to 2009 and, between 2009 and 2013, was the Chief Executive of the Youth Justice Board for England and Wales. He conducted the serious case review from early 2019. His report (“the SCR report”) was published in May 2020. The reference in the Coroner's reasons to the PCIR and PCAR are to two reports prepared by the Metropolitan Police into a complaint made by the Claimant. The Claimant first complained to the Independent...