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A damning report into the treatment of a woman in the months before she was brutally killed by her jealous husband has highlighted a number of missed opportunities by the authorities.
The findings of an independent domestic homicide review into the death of 33-year-old Natalie Esack show glaring errors and a lack of communication between police and health officials.
Mrs Esack was stabbed to death by her husband Ivan in her Ashford salon on April 30, 2012.
Mr Esack, a former Maidstone police detective, was found guilty of murdering his estranged wife in her Ashford hair salon because he was so jealous of her new lover.
Calculating Esack, 38, plunged a kitchen knife into Natalie up to 11 times as she desperately tried to escape into a basement.
He was jailed for life after a three-week trial in January last year.
But the review into the authorities' handling of the domestic violence leading up to the murder has shown a number of areas of concern.
It said police could have arrested Esack for sending "malicious communications" to Natalie; they also didn't act on Natalie's report that her estranged husband might harm himself, or that he had been carrying a knife when he went to her address in February.
There had been evidence of an increasing rate of domestic violence in the six months leading up to the fatal attack, the report revealed.
By the month before the fatal stabbing at Esack Hair and Beauty in Ashford, "there were a number of risk factors in (Esack's) circumstances and behaviour", the report reveals.
"He took cocaine and drank heavily, but there is no evidence that he was dependent on these substances.
"He described himself as depressed and stressed."
He did not accept that his relationship with Natalie was over after she left him in February of that year.
The report adds: "He was extremely jealous and, after their separation in February 2012, harassed (Natalie) through persistent texts, phone calls and visits."
He also made threats to kill her, and had carried a knife to her father's address, where she was living in February.
Crucially, it was also alleged by a friend that a month before her death, Esack had strangled his wife until she lost consciousness.
But, the report reveals, all that information was not collated, with different police and health workers only having a partial picture of the vital months leading up to Natalie's terrifying attack.
Had all that been connected, the Domestic Abuse Stalking and Harassment risk assessment in March of that year would have been graded high risk, and a multi-agency conference would have been held to devise a safety plan for Natalie.
Once (Esack) realised that their marriage was over, he exerted his control over (Natalie) for a final time by killing her" - report into Natalie Esack's death
A counsellor, it was revealed, knew of the strangulation, but accepted Esack's assurance he had notified police of the assault.
The report adds: "Police investigations also revealed that several friends and family members had inforamtion about the escalating domestice abuse (Natalie) suffered over many years, but no-one had the full picture."
Chillingly, the report reveals the state of Esack's mind: "Once (Esack) realised that their marriage was over, he exerted his control over (Natalie) for a final time by killing her."
The review highlights 13 recommendations, centering on communication between the various agencies involved in such an investigation.
It calls for a change in police policy regarding reports of domestic violence involving serving police officers.
It also calls for a risk assessment to be carried out when allegations of domestic violence are made against holders of a shotgun or firearms certificate.
It recommended domestic abuse training to be provided for GP surgeries.
County councillor Mike Hill, in his capacity as chairman of the Kent Community Safety Partnership, which commissioned the review, said: “We would like to express our deep sorrow and regret that a woman should die in such horrific circumstances.
"We want to take this opportunity to offer our condolences to her family.
“The commissioning of this independent review, which examines in detail the circumstances of this case, is a mark of our determination to learn and prevent future homicides from occurring.
"It also underlines the seriousness of our commitment in tackling domestic abuse.
“The review is published today for all to consider the events leading up to (Natalie Esack's) violent death at the hands of her husband.
“The Kent Community Safety Partnership fully accepts both the findings and recommendations of the review."
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