Thursday 31 October 2019

Grenfell Tower Inquiry ~ Phase 1 report

The fire and the building:

In the early hours of Wednesday 14 June 2017 a fire broke out in the kitchen of Flat 16 Grenfell Tower, a high-rise residential building in North Kensington, West London. Grenfell Tower was owned by the Royal Borough of Kensington and Chelsea (RBKC) and managed by the Royal Borough of Kensington and Chelsea Tenant Management Organisation (the TMO).

from the London Fire Brigade (LFB) attended the fire and within minutes of their arrival had extinguished the fire within the kitchen of Flat 16, but by that time the fire had already escaped into the cladding where they were unable to fight it successfully.

The building was constructed of reinforced concrete, to which there had recently been added a cladding system comprising insulation boards attached to the outside of the concrete structure and protected from the weather by aluminium composite material rainscreen panels. The rainscreen panels contained a polyethylene core. Polyethylene is a highly combustible substance. The material from which most of the insulation boards were made, polyisocyanurate foam, is also combustible.

Within 20 minutes a vertical column of flame had reached the top of the building on the east side from where it progressed around the rest of the structure, so that within a few hours it had engulfed almost the whole of the building. The fire claimed the lives of 71 people who were present in the tower that night.  Another resident who had escaped from the building died seven months later. A total of 227 people in all (residents and visitors) escaped from the tower.


Prime Minister Theresa May set up an Inquiry under the chairmanship of Sir Martin Moore-Bick - Grenfell Tower Inquiry. The Inquiry operates under the Inquiries Act 2005.

Phase I report:

On 29 October 2019, the Inquiry published its Grenfell Tower Inquiry - Phase I report 

The report is divided into six parts. Part I contains a broad introduction to the events that took place during the early hours of 14 June 2017. It contains a description of Grenfell Tower itself and of the organisation of the London Fire Brigade (LFB) and sets the scene for Part II, which contains a detailed narrative account of the fire and the steps taken in response to it. Part III contains the Inquiry conclusions about the origin and development of the fire and analysis of the response of the LFB and the other emergency services which attended the incident. The hearings commemorating those who died constituted an important part of the Inquiry’s proceedings. A summary of the tributes paid to their loved ones by their families and friends is contained Part IVPart V contains recommendations arising out of the findings made earlier in the report and Part VI looks ahead to identify some matters of particular importance on which the Inquiry will concentrate its attention in Phase 2.

Recommendations are set out at Chapter 33 which can be found in the Executive Summary - (HERE).

Chapter 34 (also in the Executive Summary) looks ahead to Phase 2 of the Inquiry which will examine the circumstances and causes of the disaster.  Phase 2 of the Inquiry is expected to begin in early 2020, following which the final report will be written and subsequently published.

The Prime Minister made a statement in the House of Commons and the Phase I report was debated - Hansard 30 October 2019. The Prime Minister stated - " ... we plan to accept in principle all the recommendations that Sir Martin makes for central Government. We will set out how we plan to do so as quickly as possible, but I can assure the House and all those affected by the Grenfell tragedy that where action is called for action will follow."

On 31 October, a debate on the report was held in the House of Lords.

A Full reading of the report is essential and the report cannot be summarised adequately in a blogpost such as this. However, it is worth noting that: 
  • The Inquiry found "compelling evidence" that the external walls of the building failed to comply with Building Regulations 2010. Phase 2 will return to this subject.
  • The report states that London Fire Brigade's preparation and planning for a fire such as that at Grenfell Tower was gravely inadequate.
  • Firefighters who attended the tower displayed extraordinary courage and selfless devotion to duty, but the first incident commanders, although experienced, were of relatively junior rank. They were faced with a situation for which they had not been properly prepared."
Other Reports:

The rapid spread of the fire was, from the outset, attributed to the exterior cladding which had been applied to the building in 2016.  On 30 August 2017, an independent review of building regulations and fire safety was announced - see the terms of reference and this issued an interim report in December 2017 and a final report in May 2018 - see the Hackitt Review.

Five further reports are helpfully summarised at BBC News 4 June 2018.   These are:

Professor Niamh Nic Daeid - Cause and spread of fire - Read the full report

Dr Barbara Lane - Fire protection measures - Read the full report

Professor Luke Bisby - Ignition of the facade materials - Read the full report

Professor Jose Torero - Spread of the fire - Read the full report

Mr Colin Todd - Statutory and regulatory requirements - Read the full report


Previous posts

BBC News 29 October - Grenfell Tower fire: 'Systemic failures' in fire brigade's response

BBC News 30 October - Grenfell: Resign now, survivors tell fire chief after critical inquiry report

BBC - The Grenfell Tower Inquiry with Eddie Mair -coverage of the Inquiry hearings and report

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