Complacency, an undue emphasis on process, and a failure to learn from the Lakanal House fire were at the heart of the London Fire Brigade’s inadequate response to the Grenfell Tower fire, according to the public inquiry.
The 2009 Lakanal House fire should have alerted the London Fire Brigade (LFB) to the shortcomings in its ability to tackle fires in high-rise buildings, says the Phase 2 report of the public inquiry, led by Sir Martin Moore-Bick. The brigade should have responded more effectively to its experience at Lakanal House and made better use of the knowledge it had gained of the dangers from modern construction materials and methods.
But those shortcomings could have been rectified if LFB had been more effectively managed and led. There was a tendency to treat problems as “undeserving of change” or “too difficult to resolve” – even when they concerned operational or public safety.
In particular, there was a failure to recognise the possibility that, in the event of a fire in a high-rise residential building, a large number of calls seeking help from inside and outside the building might occur. LFB failed to ensure suitable training for its control room operators on handling multiple fire survival calls simultaneously, and to ensure that its arrangements for handling such calls reflected national guidance. Any training that there was sometimes did not reflect national guidance, nor did it respond to the experience of control room officers who had been on duty at the time of the Lakanal House fire.
Failures were compounded by an “entrenched but unfounded assumption” that the Building Regulations were sufficient to ensure that external wall fires of the kind that occurred in other countries would not occur in the UK. After Lakanal House, senior officers recognised that compliance with the regulations could not be guaranteed, but “no one appears to have thought that firefighters needed to be trained to recognise and deal with the consequences”.
There was a failure to identify training needs combined with a “cumbersome and slow” system for commissioning new training packages, says the report. Incident command training was “poorly devised” and “was not effectively delivered”, and there was inadequate provision for refresher training and regular assessment.
LFB failed to ensure that the knowledge of the dangers of the increasing use of combustible materials held by some specialist officers – in particular the risk of external fire spread and the resulting loss of compartmentation – was shared with the wider organisation. In addition, firefighters were not given proper training or guidance on carrying out inspections of complex buildings, and there were no effective arrangements for sharing information about risks posed by particular buildings. Astonishingly, policy on high-rise firefighting “did not reflect national guidance” and senior management “failed to recognise that producing contingency plans for a full evacuation and training firefighters to implement them was an essential aspect of fighting fires in high-rise buildings”.
Finally, the communications equipment used at the time was “inadequate” in a high-rise building constructed largely of reinforced concrete. Although this was a well known problem, “nothing had been done to alleviate it and firefighters were not trained to recognise and respond to it”. LFB’s approach was to “do its best with what it had available”, and so it failed to make sufficient efforts to modernise its equipment, thereby “significantly impairing its operational efficiency”.
FURTHER GRENFELL INQUIRY ANALYSIS
Click here to read Ron Alalouff’s first piece of analysis into the inquiry.
Click here to read Ron’s second piece of analysis on the role of the local authority in the tragedy.
Click here to read Ron’s third piece of analysis on the role of central government in the tragedy.
Click here to read Ron’s fourth piece of analysis on the role of the manufacturers in the tragedy.
Click here to read a legal take on the Report by Annie Davies at Addleshaw Goddard.
