CT Policy and Research Officer, Rhianna Malcolm, shares the key findings and recommendations from the Grenfell Inquiry report, as well as responses from the sector.
On Wednesday 4th September 2024, the final report of the public inquiry into the Grenfell Tower fire, which killed 72 people in 2017, was published.
The inquiry panel consisted of former Lord Justice of Appeal, judge and Chairman of the inquiry, the Rt Hon Sir Martin Moore-Bick; CEO of Unity Homes and Enterprise (a housing association supporting BAME communities), Ali Akbor OBE; and, architect and registered Health and Safety Practitioner, Thouria Istephan1.
The report, which follows the second phase of the inquiry, examines how the tower block came to be in a condition that allowed the fire to spread.
The inquiry concludes that the path to the fire in the Grenfell Tower was “the culmination of decades of failure by central government and other bodies”2. The report examines serious defects in the way building safety has been managed in England and Wales and recommends a single regulator for construction industry functions which answers to a government minister.
Key Findings
- The government had been warned – The report identifies many opportunities for the government to identify the risks posed by combustible cladding, however warnings by experts following the cladding-related fire at Knowsley Heights in 1991 and a further fire seven years later, were ignored. Over the years, concerns raised by the committees of MPs, industry, the All-Party Parliamentary Group on Fire Safety and those working in the industry were ignored. The cladding was not banned because it had already been classed as meeting a British Safety standard. A standard which was flagged as inappropriate by the Environment and Transport Select Committee to determine external wall panel suitability.
- Testing proved the dangers of the cladding – A “large-scale test” carried out by the Building Research Establishment in 2001 revealed the type of cladding used on Grenfell “burned violently”. The BRE failed to draw the then Department for Communities and Local Government’s attention to how the material used on the cladding in Grenfell behaved and the dangers it presented. The department also subsequently failed to warn the construction industry about the risks the cladding posed, the results were not published and the government failed to tighten any rules3. In 2009, eight years later, six people died in a fire at Lakanal House, South London. The report found defensive attitudes to matters affecting fire safety were raised concerning the recommendations from the inquest for this fire. The coroner asked for a review of building regulations, but this was “not treated with a sense of urgency”.
- “Poorly run” housing department – The inquiry finds that the then Department for Communities and Local Government was dominated by deregulation policy, to the point that “even matters affecting the safety of life were ignored, delayed or disregarded.” The inquiry found that fire safety was left in the hands of a relatively junior official and the government disregarded calls to regulate fire risk assessors and change the Fire Safety Order.
- Reports into previous major fires were limited – The Building Research Establishment (BRE), recognised as a leader in fire safety and privatised 20 years before the Grenfell Tower fire, wrote reports on previous major fires which were “characterised by superficiality and a lack of analysis” giving the housing department a false impression on the effectiveness of the regulations and guidance. The BRE also had weaknesses in the way it carried out tests and its record-keeping which exposed it to “manipulation by unscrupulous product manufacturers”.
- “Deliberately concealed” fire risks – The inquiry identified the “systemic dishonesty” of the cladding manufacturer and sellers as a significant reason for the use of combustible material on the cladding of Grenfell Tower. Arconic, Celotex and Kingspan “deliberate and sustained strategies” to manipulate, misrepresent and mislead the test data, testing process and the market.
- Royal Borough of Kensington and Chelsea (RBKC) and its TMO – RBKC and the Tenant Management Organisation (TMO) were responsible for the management of fire safety at Grenfell Tower. RBKC failed to provide “independent or rigorous scrutiny” in their oversight of the TMO’s performance concerning health and safety. The council did not sufficiently cater for those from diverse backgrounds in response to the fire, their overall response was “muddled, slow indecisive and piecemeal” and their systems and leadership were “wholly inadequate” to the emergency4.
- The Tenant Management Organisation (TMO) – The inquiry found “entrenched reluctance on the part of the TMO’s Chief Executive” and despite recommendations from a fire consultant to produce a Fire Safety Strategy in 2009 no strategy was approved at the time of the fire. The TMO also allowed its relationship with residents to deteriorate leading to a “serious failure to observe responsibilities”.
- Lack of assigned fire safety responsibility – The inquiry found that multiple parties involved in the Grenfell Tower refit, including Studio E (architect), Rydon (principal contractor), and Harley Facades (cladding sub-contractor), failed to take proper responsibility for safety standards, resulting in a “merry-go-round of buck-passing” and a lack of attention to fire safety concerns5.
- Ill-prepared firefighters – The report notes a “chronic lack of effective management and leadership” within the London Fire Brigade. Senior management failed to ensure firefighters receive adequate control room training which reflected national guidance and did not have proper plans for numerous emergency calls or advice for trapped residents.
Who is responsible?
The Chairman of the Inquiry, Sir Martin Moore-Bick named the following organisations and individuals in his final inquiry statement: the government, the Royal Borough of Kensington and Chelsea, those who manufactured and supplied the materials in the refurbishment, those who certified their suitability on high-rise buildings, the architect, the principal contractor and some of its sub-contractor in particular, Harley Facades, some of the consultants, in particular, the fire engineer, the Local Authority Building Control Department and the London Fire Brigade.
Sir Moore-Bick acknowledged that not all bear the same weight of responsibility for the Grenfell disaster, however, he states they “all contributed in one way or another”, in most cases due to incompetence but in some cases due to dishonesty and greed.
Source: BBC News
Key recommendations
The 1,700-page report also issues 58 recommendations. Below is a summary of the report’s key recommendations:
- A single independent body, a construction regulator, reporting to a single Secretary of State (SoS). The regulator should be responsible for testing and certifying products.
- The government should bring responsibility for functions relating to fire safety into one department under a single SoS. The SoS should also appoint a Chief Construction Advisor to advise on all matters affecting the industry.
- A fire-safety strategy, written by a registered fire engineer be submitted with building control applications for the construction or refurbishment of “higher risk” buildings6.
- Legally recognise the profession of fire engineer and for an independent body to be established to regulate, define the standards of membership and maintain a register of members.
- A licensing scheme operated by a construction regulator for principal contractors wanting to refurbish higher-risk buildings. Additionally, applications for construction or refurbishment should be supported by directors or senior managers to personally “take all reasonable care” to ensure building safety.
- Data on product and material tests and reports on serious fires should be compiled in a national library managed by the construction regulator to aid future building design.
- A legal requirement should be made for the government to maintain a public archive of recommendations made by select committees, coroners and inquiries, along with the resulting actions and a record of reasons why a recommendation is not accepted.
- Local authorities should add providing immediate financial assistance to their contingency plan in for anyone affected by an emergency and ensure key workers are available to respond.
Though the recommendations stop short of impacting the work of social landlords the report calls for “others responsible for the management of social housing [to] give them careful consideration and take appropriate action accordingly.”7
Sector responses
“…justice has not been delivered. The inquiry report reveals that whenever there’s a clash between corporate interest and public safety, governments have done everything they can to avoid their responsibilities to keep people safe. The system isn’t broken, it was built this way… Over and above all, the judge concludes what we already knew, that every single loss of life was avoidable… We have an expectation that the Met Police and the CPS ensure that those who are truly responsible are held to account and brought to justice… We must never forget that at the heart of this Inquiry report is the fact that 72 people lost their lives.”–Grenfell United, Survivors and bereaved families from the Grenfell Tower Fire 8
“The government will carefully consider the report and its recommendations, to ensure that such a tragedy cannot occur again…I hope that those outside government will do the same…Given the detailed and extensive nature of the report, a further and more in-depth debate will be held at a later date.” –Sir Keir Starmer,Prime Minister9
“We welcome the Inquiry’s final report, and it is vital that all social housing landlords read and learn from the findings that apply to them. The lessons from the tragedy remain as important today as they were seven years ago. Landlords must ensure tenants are safe in their homes. They must listen to tenants, take their complaints seriously, and treat them with fairness and respect.”– Fiona MacGregor, Chief Executive of RSH10
“We wish to state on behalf of the Council that it is truly sorry for what happened at Grenfell Tower on 14 June 2017. The tragic events of that night and the people who lost their lives will never be forgotten. The bereaved, survivors and residents will forever be in the thoughts of those who work within the council.”–Royal Borough of Kensington and Chelsea, Council11
“We and our members will continue to do everything in our power to ensure that a tragedy such as the fire at Grenfell Tower never happens again…it is right that those responsible are held to account, and that other buildings with the same dangerous safety defects are made safe as quickly as possible. We welcome the Grenfell Tower Public Inquiry’s recommendations and will work with our members to learn the lessons from this report.” – Kate Henderson, NHF Chief Executive12
Note: Public inquiries cannot find guilt or innocence, they are meant to set out what happened and make recommendations, so disasters are not repeated. Governments fare not required to carry out any of the recommendations inquires make.
Further reading
- Grenfell Inquiry decides against recommending further regulation of social housing providers | News | Housing Today
- Grenfell Tower Inquiry report recommendations: The transformative, the good, the mixed and the missing (substack.com)
- The aftermath of Grenfell: A comprehensive overview of UK’s building safety reforms (shponline.co.uk)
- GRENFELL TOWER INQUIRY: PHASE 1 REPORT OVERVIEW
To discuss any issues raised in this article, please contact Rhianna Malcolm: rhianna.malcolm@campbelltickell.com
