May 14, 2021

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“Post-Grenfell, we will see changes to regulations, firefighting practice and how building materials are tested and certified, but I am not confident that we will see systemic change”

SHP speaks to Gill Kernick, Master Consultant at JMJ Associates, a specialist in safety leadership and culture and prominent Grenfell Campaigner, about her new book ‘Catastrophe and Systemic Change: Learning from the Grenfell Tower Fire and Other Disasters.’

Catastrophe and Systemic Change Learning from the Grenfell Tower Fire and Other Disasters cover

Having lived on the twenty-first floor of Grenfell Tower from 2011 to 2014, Gill Kernick has strong ties to the tragedy on 14 June 2017, in which seven of her former neighbours died. Her interest in the Grenfell tower fire is not only personal though, Gill has spent her career working in high-hazard industries, partnering with organisations to build their leadership capabilities and culture in order to prevent catastrophic events.

Gill’s book, ‘Catastrophe and Systemic Change: Learning from the Grenfell Tower Fire and Other Disasters’, published on 27 May 2021, explores the myths, the key challenges and the conditions that inhibit learning, and it identifies opportunities to positively disrupt the status quo. It offers an accessible model for systemic change, not as a definitive solution but as a framework to evoke reflection, enquiry and proper debate.

Click here to listen to this interview in full…

“Naively I imagined that the worst residential fire in London since World War II – a fire that killed seventy-two people in the UK’s richest borough – would engender a desire to learn and change,” Gill told SHP. “I was wrong. After discovering the multiple failed opportunities to learn, and realising that, far from being an isolated ‘bad building’, Grenfell revealed systemic failures in building safety and construction across the country.

“History predicted that we’d find out what happened, identify lessons and then fail to learn them.

“Rather than focus only on Grenfell, I needed to understand why we don’t learn from catastrophic events more broadly. Whether it be the COVID-19 pandemic or the Boeing Max air disasters, there is an ‘awful sameness’ to these tragedies, a horrific unifying failure to heed plentiful warnings and change.”

In an attempt to understand why our failure to learn makes sense, Gill explores two questions in the book.

  • Why don’t we learn?
  • What would it take to enable systemic change?

It is both a personal and a professional account of her own investigations and reflections, its intent is to promote enquiry and debate in the hope that it will help us learn from – and therefore prevent – catastrophic events. “My hope is that the book will spark some insight or thought that will provoke new actions that collectively, little step by little step will help us learn and change,” Gill added.

Ahead of the publish date, Gill again sat down with me and IFSEC Global Editor, James Moore to discuss the reasons behind the book and what she learnt along the way. To hear Gill’s initial interview, about the pressing need to improve building safety culture post-Grenfell, scroll to the bottom of this article, or click here to read the IFSEC Global report.

What do you mean by ‘systemic’ culture change?

Gill KernickGill Kernick (GK): “Distinguishing between piecemeal change and systemic change is helpful. The former impacts parts of the system: building regulations, for example, or technical competency. Systemic change, by contrast, requires ‘shifting the conditions that are holding the problem in place’.

“Most of the responses to Grenfell and other disasters are piecemeal: changing parts of the system but not the system itself. Piecemeal change will happen post Grenfell, and it is absolutely critical that it does. We will see changes to regulations and to firefighting practice, we will see changes to what materials are used when buildings are erected and to how they are tested and certified. I am not at all confident, though, that we will see systemic change.

“So, for example, regarding resident’s voices being heard, a piecemeal solution might be a new complaints process, which is important – but without shifting the conditions holding our failure to listen in place – we won’t see systemic change. To do so we’d need to understand and shift deeply held biases about social housing tenants. We’d need to address why residents are not treated with ‘dignity, or humanity or empathy’. (in the words of Grenfell survivor and activist Eddie Daffarn). Systemic change is far more complex but without it, we will never truly learn from disasters such as Grenfell.”

At what point did you realise that systematic failure was in part, or fully, to blame for the events of June 14, 2017?

(GK): “The combination of the failures to learn from previous events and the scale of the building safety issues exposed since Grenfell.

“A particular moment sticks in my mind when it began to dawn on me the enormity of the failure to learn and prevent Grenfell. It was the moment when, through tears, I read evidence given to a Select Committee in June 1999 – 18 years before Grenfell. Set up to investigate a fire in Scotland that killed disabled resident Alexander Linton, the Fire Brigade Union said:

“‘The primary risk therefore of a cladding system is that of providing a vehicle for assisting uncontrolled fire spread up the outer face of the building, with the strong possibility of the fire re-entering the building at higher levels via windows or other unprotected areas in the face of the building’.”

Was the process of writing something so close to your heart challenging and how much did your perspective of the event change during the writing process?

(GK): “It is the hardest thing I’ve done. It was intellectually both challenging and interesting but, at times, during the research especially, I’d get overwhelmed by the human impact. I recall watching a video of a European test of cladding that exposed the flammable PE core to flames and bursting into tears. The UK test only exposed the aluminium surface of the cladding to flame. And we all know the devastating impact the exposed PE core had that night.

“I spent a lot of time sitting at the base of Grenfell tower thinking about what to write. To keep me true to the intent of what I was doing.

You mention a ‘culture of finger pointing/blame’ in the book – how do you think the industry has ended up in this situation?

“I think blame and finger pointing are as much a human as an industry issue. When things go wrong our natural reaction is to look for who to blame. It can be emotionally satisfying to find the ‘bad apple’ and remove or punish them. But it doesn’t fix anything and can mask deeper systemic issues and drive unwanted behaviours. For example, where people are afraid to speak up and admit they’ve made a mistake for fear of retribution.

“Blame and learning do not co-exist well.

“That is not to say there shouldn’t be consequences for those that fail to fulfil on their accountabilities. Appropriately borne consequences are also critical for learning.

“You need to balance these complex issues carefully.”

What would fire safety professionals get out of the book?

(GK): “My hope is that reading the book will highlight how relational and contextual elements contribute to catastrophic events. That how we listen, and our attitudes and biases are as important as regulations and technical issues. My experience post-Grenfell is that a lot of attention is given to technical issues, less so to the ‘softer’ leadership and cultural sides of preventing catastrophic events.”

What can professionals in construction/building safety do to contribute towards systemic change?

(GK): “Stop accepting bad practice and build safe, high – quality buildings.

“Stop bidding for jobs that offer margins that mean you have to compromise safety and quality.

“Stop procuring on cost alone. Pay for safe quality work. It will cost you less in the long run.”

What would your one tip be for challenging the status quo and affecting real change within an organisation?

(GK): “Boards and executives should listen and learn from those at the sharp edge.”

£1.50 from each purchase of the book goes to Grenfell Fund if ordered through a specific link. Can you tell us a little more about who the Grenfell Fund is helping?

(GK): “My publisher, the London Publishing Partnership, is giving £1.50 to the Grenfell Foundation for any books that are pre-ordered via their website before May 27th.

“The Foundation was set up at the request of some survivors and bereaved families of the Grenfell Tower fire to provide independent support to the former residents of Grenfell Tower, their families, dependents, and the local community.

“In the weeks and months after the Grenfell fire, people across the country showed incredible generosity to everyone affected and that continues to this day. The Grenfell Foundation helps to channel that spirit and the funds raised to local projects.  Projects span areas such as remembrance, awareness, wellbeing and community.”

And lastly, where can people get hold of a copy of the book?

(GK): “It is available from most online bookshops or directly from my publisher the London Publishing Partnership.”

Safety & Health Podcast

Listen, as Gill Kernick talks about the pressing need to improve building safety culture post-Grenfell.

Subscribe and tune in the Safety & Health Podcast to discover the latest issues facing the health and safety profession, and stay on-top of the developments affecting your role, from working at height, lone working and common workplace hazards, to safety culture, behaviours, occupational health and mental health and wellbeing.

Fire Safety in 2023 eBook

SHP's sister site, IFSEC Insider has released its annual Fire Safety Report for 2023, keeping you up to date with the biggest news and prosecution stories from around the industry.

Chapters include important updates such as the Fire Safety (England) Regulations 2022 and an overview of the new British Standard for the digital management of fire safety information.

Plus, explore the growing risks of lithium-ion battery fires and hear from experts in disability evacuation and social housing.

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Steve Hembury
Steve Hembury
3 years ago

I have just ordered this book and excited to read Gill’s views. I’m hoping the book addresses culture in the UK and I am talking about a safety culture, not just building safety, fire safety or any other specific safety issue. The safety culture within the UK is not good enough. Until boards, senior leaders, government officials, business owners etc can truly change this culture of profit over safety then I am afraid we will not see the changes we need to. We have become a throw away society that accepts poor standards. It is not sustainable. I have and… Read more »

Gill Kernick
Gill Kernick
3 years ago
Reply to  Steve Hembury

Steve, thank you for ordering the book. I do look at safety culture. I’m interested in your views after reading it.