THE fire at Grenfell Tower, Britain’s worst residential fire since the Second World War, was the culmination of “decades of failure by central government and other bodies in positions of responsibility in the construction industry”, the official inquiry has concluded (News, 1 November 2019).
The inquiry was announced the day after the fire in June 2017 (News, 16 June 2017). Its final report condemns “systematic dishonesty” on the part of those who made and sold the cladding panels and insulation products used on the high-rise tower block.
Seventy-two people were killed in the blaze.
“The simple truth is that the deaths that occurred were all avoidable, and that those who lived in the tower were badly failed over a number of years and in a number of different ways by those who were responsible for ensuring the safety of the building and its occupants,” the chair, Sir Martin Moore-Bick, said on Wednesday.
The Archbishop of Canterbury said in a statement that afternoon that it had been “chilling to read that systematic dishonesty and a refusal to listen to concerns were in part to blame for Grenfell Tower becoming a death trap. This is a dreadful reminder that human lives should never be sacrificed in the pursuit of profit.”
Dr Graham Tomlin, who served as the Bishop of Kensington from 2015 to 2022 and has advocated for survivors and the bereaved families, described the report as “devastating. It tells a story of systemic failure, disregard for safety, companies, organisations, and individuals turning a blind eye to repeated warnings of what could happen.”
The seven-volume report identifies failings on the part of both public- and private- sector bodies, including the Government, the Tenant Management Organisation, the Royal Borough of Kensington and Chelsea, those who manufactured and supplied the materials used in the refurbishment, the architect (Studio E), and the London Fire Brigade.
“Not all of them bear the same degree of responsibility for the eventual disaster, but, as our reports show, all contributed to it in one way or another, in most cases through incompetence but in some cases through dishonesty and greed,” Sir Martin said.
The report is highly critical of the Department for Communities and Local Government, led between 2010 and 2015 by Sir Eric Pickles. It records that, by 2016, the department was “well aware” of the risks posed by the use of combustible cladding panels and insulation, particularly to high-rise buildings, but “failed to act on what it knew”.
In the years after the Lakanal House fire of 2009, in which six people died, “the government’s deregulatory agenda, enthusiastically supported by some junior ministers and the Secretary of State, dominated the department’s thinking to such an extent that even matters affecting the safety of life were ignored, delayed or disregarded,” the report says.
It is also damning about the companies that supplied the combustible materials used in the refurbishment of the tower between 2012 and 2016, concluding that they “engaged in deliberate and sustained strategies to manipulate the testing processes, misrepresent test data, and mislead the market”.
Arconic, which supplied rainscreen panels, “deliberately concealed from the market” the true extent of the danger of using its product in the form used on the tower. The company was, the report says, “determined to exploit what it saw as weak regulatory regimes in certain countries (including the UK)”.
At the time the inquiry was launched, Kingspan, which manufactured insulation, was still knowingly creating a “false market” for its product for use on high-rise buildings, having made a “false claim” about its safety, the report says.
Sir Martin’s report also exposes serious failures of regulation and compliance. Bodies were compromised by their close relationship with companies. Among his recommendations is the appointment of a construction regulator to oversee all aspects of the construction industry.
”The dishonest strategies of Arconic and Kingspan succeeded in a large measure due to the incompetence of the British Board of Agrément [an organisation that certifies the compliance of products], its failure to adhere robustly to the system of checks it had put in place, and an ingrained willingness to accommodate customers instead of insisting on high standards and adherence to a contract that was intended to maintain them,” the report says.
The Building Research Establishment was marred by “unprofessional conduct, inadequate practices, a lack of effective oversight, poor reporting and a lack of scientific rigour”, while the Local Authority Building Control “failed to scrutinise properly the claims made for the products by the manufacturers and instead adopted uncritically the language they suggest.
“In short, it was willing to accommodate the customer at the expense of those who relied on the certificates.”
The architect, Studio E, is described as bearing “a very significant degree of responsibility for the disaster”.
Completed in 1974, the 24-storey Tower was owned by the London Borough of Kensington and Chelsea and managed by the Tenant Management Organisation, whose relationship with residents had deteriorated into a “toxic atmosphere”, Sir Martin’s report says.
The TMO “lost sight of the fact that the residents were people who depended on it for a safe and decent home and the privacy and dignity that a home should provide”, it says. The TMO came to regard fire safety as “an inconvenience rather than an essential aspect of its duty to manage its property carefully”.
A single person, Carl Stokes, was employed as fire-risk assessor for the entire estate, despite lacking qualifications and experience. The TMO appointed Studio E as architects, despite the fact that the firm had no experience of over-cladding a high-rise building.
The Royal Borough of Kensington Council took “little or no account” of a highly critical review of fire safety carried out for the TMO in 2009. The years between 2009 and 2017 were “were marked by a persistent indifference to fire safety, particularly the safety of vulnerable people”.
The London Fire Brigade is described as suffering from a “chronic lack of effective management and leadership, combined with an undue emphasis on process”.
The response of the Government and local council to the fire in the first week was “muddled, slow, indecisive and piecemeal” and the council’s leadership is described in the report as “wholly inadequate” to the task.
“Certain aspects of the response demonstrated a marked lack of respect for human decency and dignity and left many of those immediately affected feeling abandoned by authority and utterly helpless.”
The report concludes: “Those who emerge from the events with the greatest credit, and whose contribution only emphasised the inadequacies of the official response, are the members of the local community. With the support of local voluntary organisations, they provided support in the hours immediately following the fire when the authorities were conspicuous by their absence.”
On Wednesday, the deputy assistant commissioner of the Metropolitan Police, Stuart Cundy, said that the force would need to “examine the report — line by line — alongside the evidence from the criminal investigation”. This would take at least 12 to 18 months. A team of 180 officers and staff is engaged in this investigation: nine companies or organisations and 58 individuals are listed as suspects.
A statement from Grenfell United, which represents survivors and bereaved families, said that the report represented “a significant chapter in the journey to truth, justice and change. But 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. . . We were failed in most cases by incompetence and in many cases by calculated dishonesty and greed.”
Archbishop Welby said that justice for the survivors and bereaved — whom he praised for their bravery in testifying to the inquiry — was “long overdue”. The findings must “prompt deep reflection and meaningful change from all those identified as having failed victims”.
He repeated his calls for a fairer housing system, which, he said, should be a place of safety. “Home was not that for the residents of the Grenfell Tower. This tragedy shows us that we must cherish and protect everyone in our society, and that safety should not just be the preserve of the wealthy.”
Dr Tomlin said: “The report is an exercise in truth-telling, identifying wrongs that were committed, which is itself an important step towards justice and a more lasting peace of mind and heart that such justice could bring.
“Jesus once said ‘will not God grant justice to those who cry out to him day and night?’ Those caught up in this tragedy have been crying for such justice for seven years and this report is hopefully a step in that direction.”