Reports into the killing of two people by a man with schizophrenia have sparked calls for better sharing of information in management of mental health patients.
Two reports for NHS London into the care of Peter Bryan by East London foundation trust and West London mental health trust were published last week.
Mr Bryan killed friend Brian Cherry and ate parts of his brain in 2004, two years after he was released from a secure hospital for a previous killing.
Later in 2004 he attacked fellow patient Richard Loudwell at Broadmoor high security hospital, which is run by East London foundation.
Independent reports were carried out into both incidents.
NHS London, in response, said there were lessons for the whole NHS, particularly that only professionals with enough experience and training should have responsibility managing and treating patients.
The strategic health authority said there also needed to be better sharing of information and improved communication between all agencies.
NHS London chief nurse Trish Morris-Thompson said: “We accept that there were shortcomings in the care and treatment… and apologise to the families of those involved for the distress that this has caused.
“East London foundation trust has agreed a joint action plan with Newham Primary Care Trust and its local authority.
“This will be followed up and overseen by Newham PCT and [foundation trust regulator] Monitor.
“In addition West London Mental Health trust has produced an action plan which we will need to approve and subsequently monitor.
“However, it must be said due to the long and time-consuming inquiry process a substantial amount of work has already taken place.”