A DAMNING report has shown how mental health services failed patient Matthew Daley and could have prevented him from killing pensioner Don Lock.

NHS England has published an independent report in the care of their patient up until the moment he crashed into Don Lock and then stabbed him 40 times at the side of the road in July 2015.

The report states that the Trust had ‘failed to undertake robust assessments in relation to psychosis and autism, this led to a flawed set of assumptions about how to manage him.

The report concludes that the “the root cause of this incident lies in the Trust’s failure to ensure that robust assessments were undertaken”.

NHS found “clear evidence that Daley’s levels of violence had increased such that serious harm to others was increasingly likely.

The report adds: “However we acknowledge that staff could not have predicted that Daley would have killed Mr Lock in the way that he did in July 2015.”

Read more: NHS apologises for failing to prevent Matthew Daley stabbing Don Lock

Daley, a paranoid schizophrenic, knifed the great-grandfather to death and was jailed for life with a minimum of ten years.

The then 35-year-old stabbed Don Lock repeatedly on the side of the road in July 2015, leaving 35 stab wounds.

He attacked the retired solicitor, 79, on the A24 near Findon after a shunt between their cars.

Daley admitted killing Mr Lock but was cleared of murder after a trial in May when the jury accepted his defence of diminished responsibility due to his mental health problems.

The trust has apologised following the report, which states:

  • Mr W had been under the care of the Trust for more than seven years at the time of Mr Lock’s death. We can see that Trust staff did make efforts to engage Mr W. However, because the Trust had failed to undertake robust assessments in relation to psychosis and autism, this led to a flawed set of assumptions about how to manage Mr W.
  • Added to this was the fact that staff considered his violent behaviours as matters for the criminal justice system, and not directly related to his mental illness. This position denied him the opportunity to receive appropriate treatment and consequently resulted in his behaviours gradually escalating over time.
  • Had Daley been in receipt of effective therapy starting at any stage between 2008 and 2015 the tragic death of Mr Lock may have been avoided.
  • It is our opinion that the root cause of this incident lies in the Trust’s failure to ensure that robust assessments were undertaken, in accordance with NICE guidelines.