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AN OFFICIAL REPORT into the Grenfell Tower tragedy has found that fewer people were likely to have died in the fire if “serious shortcomings” had not plagued the fire service’s response.
The public inquiry’s first report into the blaze, due to be published on Wednesday but seen by the PA news agency, identified “systemic” failures by the London Fire Brigade (LFB).
It also accused the brigade’s commissioner Dany Cotton of “remarkable insensitivity” after she said she would not have done anything differently on the night that fire occurred.
The report concluded that the fire, in which 72 people died in June 2017, started as the result of an electrical fault in the building.
But inquiry chairman Sir Martin Moore-Bick said fewer people may have died if key decisions had been made earlier.
He made a number of recommendations following the two-year investigation into how the disaster at the west London tower block unfolded.
In the report, Sir Martin said the “principal reason” that flames shot up the building at such speed was because the combustible aluminium composite material cladding with polyethylene cores acted as a “source of fuel”.
The panels were added in the refurbishment of the tower before to the June 2017 fire.
General Secretary of the Fire Brigades Union Matt Wrack told the BBC the ordering of the inquiry was “completely back-to-front” – a concern which has previously been voiced by the local community.
“Firefighters’ actions on the night, which were remarkable in the circumstances, are now being scrutinised,” he said.
“Nobody is trying to avoid scrutiny, but we think that the ordering of the inquiry is completely back-to-front.”
Electrical fault
Meanwhile, the report also found that the fire started as a result of an “electrical fault in a large fridge-freezer” in a fourth-floor flat in the complex.
Sir Martin said Behailu Kebede, who had lived in the flat, bore no blame for the fire.
Survivors had previously urged the judge to make a point of formally exonerating the resident, who was offered police protection after false reports of his culpability circulated online.
The judge said he had not intended to investigate whether the building complied with regulations at this stage, but added that there was already “compelling evidence” that the external walls did not.
Instead of adequately resisting the spread of fire, they “actively promoted it”, he said.
Sir Martin also criticised the London Fire Brigade for its “stay-put” strategy when residents were told to remain in their flats by firefighters and 999 operators for nearly two hours after the blaze broke out just before 1am.
The strategy was rescinded at 2.47am.
Sir Martin said: “That decision could and should have been made between 1.30am and 1.50am and would be likely to have resulted in fewer fatalities.
I identify a number of serious shortcomings in the response of the LFB, both in the operation of the control room and on the incident ground.
“The best part of an hour was lost before Assistant Commissioner Roe revoked the ‘stay put’ advice.”
He added: “It is right to recognise that those shortcomings were for the most part systemic in nature.”
Lessons not learned
Sir Martin also described the service’s preparation and planning for a fire such as the one that occurred at Grenfell Tower as “gravely inadequate”.
He praised the heroics and bravery of individual firefighters, but described the “stay put” strategy as an “article of faith within the LFB so powerful that to depart from it was to all intents and purposes unthinkable”.
And he said those giving advice to trapped residents during 999 calls were “not aware of the danger of assuming that crews would always reach callers” – a key lesson from the Lakanal House fire in 2009, when six people died.
Sir Martin also took exception to Cotton’s “remarkably insensitive” evidence that she would not change anything about the response of the fire service on the night.
“The Commissioner’s evidence that she would not change anything about the response… even with the benefit of hindsight, only serves to demonstrate that the LFB is an institution at risk of not learning the lessons of the Grenfell Tower fire,” he said.
He also said that Cotton’s evidence “betrayed an unwillingness to confront the fact that by 2017 the LFB knew (even if she personally did not) that there was a more than negligible risk of a serious fire in a high rise building with a cladding system”.
Cotton announced her retirement in June.
An LFB spokeswoman said: “The inquiry’s findings are not being published until Wednesday morning and it would be inappropriate for us to comment on them until then.”
An inquiry spokeswoman said the chairman and whole team were “dismayed and disappointed” that media had “chosen to deprive those most affected by the fire – the bereaved, survivors and residents – the opportunity to read the report at their own pace and without the distraction of public discussion and commentary ahead of publication”.
She added: “The inquiry has no further comment to make at this time.”
The inquiry’s second phase is due to start in the new year.
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The fire service here and in the UK has become hamstrung by rigid operational procedures that do not allow for critical thinking in all ranks. Health and Safety legislation, some of which is unsuitable for fire operations is used as a blunt tool to drive this.
Couple this with a top heavy Senior Officer contingent, laden with Engineering degrees and no operational experience and you have a recipe for disaster.
Modern Firefighters are being trained like robots, not problem solvers, with those that have valuable operational experience being cast aside as pariahs.
@Etherman: Unfortunately ever word is so true. The system has overtaken the many experienced people and personnel who have the experience. Red tape and ARSE covering is foremost in the thinking
@Etherman: I recently read a book by an assistant commissioner of the LFB who did her PhD research on how they make on-scene decisions. It seemed as though all the senior officers had raised through the ranks, regardless of degrees, and in fact were highly reliant upon experience to make decisions. So much so that they modified the training in the FB to augment experiential learning
@Etherman: much of what you say is bang on, though it should be said that with correctly built apartments, the stay put advice is still sound. Sadly, that means those engineers you talk about should have been doing their jobs better in the first place.
When you calculate out the savings between the cladding they used and the next grade up, it was buttons.
I sincerely hope (as a serving member of the fire service) that the LFB don’t ship too much flak for this on the ground.
@Vocal Outrage: My reference to fire engineers is more relevant to the Irish Fire Service. The UK still leads the way in training with Irish Fire Services sending scores of instructors and recruits there for that reason. Also, Irish Fire Service operational guidelines are based on UK literature, sometimes word for word.
Still, watch those who made policy, designed flawed buildings and created dogmatic rules that couldn’t be broken for fear of discipline proceedings, fade into the background.
None of them have ever faced those initial moments of critical decision making that operational Firefighters and Officers routinely make in the initial stage of an incident. No training scenario can ever recreate it.
@John Tobin: correct
It was a giant candle ffs. Nice deflection in trying to blame the fb
Hindsight is great…the proven strategy at the time was to stay put. How would a firefighter know that this would be wrong when all previous experience tells them it is right?
anything to deflect the blame from those really responsible – the developers who commissioned the building and the ‘cut backs’ in using poor quality materials , the contractors who used those materials and the local authority building surveyors who passed the building as fit for purpose, the local authority housing office that allowed overcrowding in most of the flats with families of six or more living in a 2 bed flat — thats where the blame lies -not with london fire brigade who have been cut back to the bone by successive tory governments and fools running as london mayor- maybe if it wasnt for the like of boris johnson and sadiq khan closing down streets and narrowing roadways so as large vehicles struggle to get around the city those fire crews might have got to grenfell a few minutes earlier and saved more lives – as it was they did an outstanding job in the most difficult conditions — when you cut back on essential pubic services you have NO RIGHT to level criticism and blame against them when the shit hits the fan !
@Eric Davies: exactly my thoughts reading that, deflect responsibility to the people trying to help & away from the actual cause of the problem.
@Eric Davies: spot on.
That’s what happens with austerity…
Nobody in the fb could have done anything differently that night. Cowardly, contrived report.
Throwing the firefighters that deliberately put their lives on the line to help others under the bus. Essentially the report says that something that wasn’t meant to be there was there and it’s the firefighters fault even though they didn’t put it there.
So it is blame the fire brigade but not the people responsible for the cuts to that service. Boris Johnson has a lot to answer for in his time as mayor. Same goes for Sadiq Khan.
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