The four-month-old grandson of football manager Steve Bruce died after he was placed in an "unsafe sleeping position" on his front by an unregulated maternity nurse, an inquest heard.

Madison Bruce Smith was found unresponsive by his father, ex-Leeds United striker Matt Smith, at their home in Trafford in 2024.

Smith and his wife, Bruce's daughter Amy, had employed Eva Clements via Ruthie Maternity Services believing she was skilled, trained and vetted and the firm was well established. Neither was regulated.

In a narrative conclusion at Stockport Coroner's Court, the coroner said "his cause of death could not be ascertained" having been "placed in a prone and unsafe sleeping position".

Senior coroner for south Manchester Alison Mutch issued a prevention of future deaths report to the Secretary of State for Health calling for regulation.

The inquest heard Clements was employed after Madison had suffered difficulties sleeping in the afternoons.

Ruth Asare, head of Ruthie Maternity Services, said she had no medical qualifications and had only a first aid certificate and a Level 2 diploma in post-natal care gained from from a three-day course and a six-month coursework project.

Clements said she had a degree in early years education but admitted she had no medical qualifications.

The inquest heard Madison's parents would "never have dreamed" of putting their son asleep in the prone position but for the advice of the maternity nurse who was said to have informed them all four of her own babies had slept on their stomachs with no problems.

Such advice was contrary to recognised safe sleeping guidance from the NHS and health professionals for young babies.

Senior coroner Mutch added the "purported expertise" of untrained people posed a risk to all children where those unregulated services were used.

She said: "I hope the services can be regulated and, going forward, parents are not left in a situation where they believe they are employing someone who is qualified to advise them when they are clearly unqualified."

She went on: "We have been told that in effect any of us could leave the building today and call ourselves a maternity nurse as while the term 'registered nurse' is strictly controlled, the term 'nurse' is not.

"It gives an illusion of someone who is highly trained and able to support parents."

She said Clements had slept in a different room and had responsibility for checking on Madison but, although he was heard through a baby monitor to stir a number of times during the night and had cried, she had not gone into his nursery.

Madison's parents, together with Bruce, who was most recently manager of Blackpool FC, and his son, ex-footballer and first-team coach at Salford City, Alex Bruce, attended the hearing.

Former Manchester United player Bruce was managing Blackpool at the time of the incident and missed the club's following game. In a message posted on the club's official X account, he had said: "It's been the worst time of my family's entire lives and is something no family should have to endure."

In a statement read to the court, Smith said the couple's son was their "precious, perfect little boy".

He said: "Losing Madison has been utterly excruciating. The pain is indescribable and often too much to bear. It has totally shattered our entire family.

"We believe that Madison died in a complete regulatory vacuum. Without regulation this will happen again and other parents will place trust in individuals who should not be in the care of infants."

The inquest heard Ruthie Maternity Services trained individuals on one-day courses for a fee of £450.

Asare told the coroner that those she trained were given the safe sleeping advice to put babies on their backs.

However, Clements said she had been taught by Asare to put babies on their stomachs.

She denied telling Madison's mother she was a nurse and also denied suggestions she had "convinced her" the prone position was appropriate.

The court heard police conducted an investigation and arrested Clement on suspicion of neglect.

Det Ch Insp Matthew Dixon, of Greater Manchester Police, said the Crown Prosecution Service was approached for directions and guidance, and it was identified that the criminal threshold had not been met.

He said this was mainly because of the unregulation of such maternity services and that it was not illegal to place a baby on its front.

He added it could not be determined that Clements set out to wilfully harm Madison.

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