The “entirely preventable” death of a grandmother in Bexleyheath at the hands of a psychiatric patient was down to failings of the NHS and police, a report has concluded.
Nicola Edgington killed Sally Hodkin with a meat cleaver in 2011, six years after the patient killed her own mother.
On the day of the murder, Edgington repeatedly called police to beg for help and told A&E staff she needed to be sectioned and felt like killing someone.
MORE: Police missed chance to detain murderer Nicola Edgington on day she killed, report reveals
Although she was taken to Oxleas House mental health unit in Woolwich to be admitted, she was able to freely walk out of the unit to commit the crime.
The damning report, commissioned by NHS England, concluded that a series of mistakes primarily by the care staff at Oxleas were to blame for what happened.
Len Hodkin, Sally’s 40-year-old son, said it was a tragedy that two grandchildren never met his mother "or got to know what a wonderful lady she was".
MORE: Multiple homicides by Oxleas mental health patients besides Nicola Edgington
The solicitor from Eltham said: “To say that we are totally devastated does not even come close to describing how we feel as a family.
“It's the unexpected nature of how she died but also when you find out it's not a car accident, but was committed by somebody that's killed before, who was let out into the community and who should have been recalled back, that's devastating.
“She killed her own mum in 2005, she was released after just three years back into the community. This isn't right and doesn't sit right with us.
“And when there were opportunities for her to be recalled back after discharge, the trust didn't do that because their concern isn't for the safety of the public or how much of a danger she is to anyone else, their primary concern is 'is she unwell?' and 'is she taking her treatment?'.
“Another thing we're annoyed about is that the trust was supposed to notify the multi-agency teams - social services and the police - that she was back in the community but the report says the person at Oxleas didn't bother sending it out.”
MORE: Bexleyheath knife murderer Nicola Edgington jailed for life
Edgington was convicted in 2006 of the manslaughter of her mother, Marion, and ordered to be detained indefinitely under the Mental Health Act.
But staff at the Bracton Centre, run by Oxleas, deemed her fit for discharge after three years and she was released in 2009 and allowed to live in the community.
Investigators behind the new report said Bracton Centre staff were too willing to accept Edgington's version of events and said documents failed to detail all the concerns about her behaviour before discharge.
The report said Oxleas staff failed to take seriously warnings made by her brother and sister that Edgington was still unwell and potentially dangerous.
MORE: Nurses fired for lying how they chased killer Nicola Edgington
The report said: "The care team were too ready to accept (Edgington's) account of potentially worrying situations, and not enough weight was given to alternative accounts, or no attempt was made to get the views of family members involved.”
The MoJ asked for details of any concerns during her trip to Jamaica to see her husband, where her husband said she threatened him with a knife, but these where never handed over by the trust.
On the day of the murder, two members of staff from Oxleas said that Edgington had for forcefully pushed through the unit's doors and that they went out to search for her.
CCTV footage showed that in fact she had calmly walked out of the building and was not pursued by any member of staff, and the staff members were dismissed for their inaccurate reports.
The report also pointed to missed opportunities by the police to section Edgington under the Mental Health Act on the day of the murder.
It said officers and police staff also did not carry out a Police National Computer (PNC) check during their repeated interactions with her, which would have alerted them to her conviction for manslaughter.
Several of Edgington's 999 calls from the A&E department were also downgraded because she was considered to be in a place of safety and an officer was not asked to return, despite Edgington saying she could be very dangerous.
The family has accepted an out-of-court settlement from Oxleas NHS Foundation Trust after filing for damages.
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