Module 3 Opening Statements - Monday 29th March 2021 (2/2)

Full transcript

00:00:10 good afternoon everyone welcome back we are now going to hear further opening statements from other court participants the next person i'm going to invite to addresses is mr

00:00:22 addresses is mr maxwell scott qc and i'm just going to check that i think i can see him there but check that he can hear me and see me good afternoon mr mexican afternoon i can indeed it's good thank you very

00:00:34 i can indeed it's good thank you very much um

00:00:35 much um well uh i think there's nothing more to be said other than than to invite you to make the opening statement on behalf of the council mr chairman panel members i

00:00:48 mr chairman panel members i together with katie sage and bethany condron

00:00:52 condron represent the role borough of kensington and chelsea instructed by dwf solicitors as you know we have submitted a 50-page written opening which i anticipate the inquiry will make

00:01:04 which i anticipate the inquiry will make public later today we also last week provided the inquiry with a document identifying some key changes made within the council since the fire that are relevant to

00:01:15 since the fire that are relevant to module 3 issues i do not intend in this oral statement to repeat all of the points made in our written opening rather i wish to identify some themes

00:01:26 rather i wish to identify some themes which are likely to be important during module three before doing so may i take this opportunity to say that the council is truly sorry

00:01:37 to say that the council is truly sorry for the suffering and tragic loss of life caused by the grenfell tower fire as the leader of the council has previously stated the council could have and should have

00:01:48 the council could have and should have done more to stop it happening the council has adopted the charter for families bereaved through public tragedy it is committed to candor in its

00:01:59 it is committed to candor in its approach to this inquiry there are six topics which i will address you on in this opening the first is the council's role in relation to module 3 issues

00:02:11 relation to module 3 issues and the council's monitoring of the tmo about half of this opening will focus on this topic the other topics will be expert evidence and

00:02:22 other topics will be expert evidence and guidance documents the role of professional fire risk assessors in the years before the grenfell fire residents with vulnerabilities flat

00:02:34 residents with vulnerabilities flat entrance doors and self-closers and finally complaints

00:02:40 in our phase one opening statement we identified ten principal ways in which the council was involved with grenfell tower and its residents both before and after the fire

00:02:51 the fire in this module we are concerned with four of them which i can summarize in this way

00:02:57 this way the council was the owner of grenfell tower

00:03:00 tower the residents were its tenants and leaseholders the council was their landlord

00:03:06 landlord both before and after the refurbishment the council worked closely with and monitored the tmos performance in module 1 some of the council's involvement was in areas in which the

00:03:18 involvement was in areas in which the tmo had no involvement planning was an example of that but the most important example was building control

00:03:27 control you will recall that council identified and apologized for a number of failings in a way the council's building control service

00:03:36 service processed and considered the application for building control approval in this module we have identified a number of specific failings

00:03:46 failings in the council's monitoring of the tmo they are set out in the council's written opening statement and i will mention some of them later in this oral statement

00:03:57 this oral statement the council apologizes for its failings

00:04:02 module three will be different to module one

00:04:05 one because in module three whenever you are considering the council's involvement you will also be considering the tmos involvement in relation to the same issue

00:04:15 issue the tmo managed grenfell tower for the council and the council paid as a management fee for doing so as your expert dr lane explains in her expert report

00:04:27 expert report the effect of this management arrangement was that the tmo has consistently been the responsible person for grenfell tower since the fire safety order was introduced in 2006.

00:04:40 introduced in 2006. tmo was the most significant of the responsible person to the grenfell tower due to the extent of its control over the premises tmo was responsible for the formulation

00:04:52 tmo was responsible for the formulation planning implementation and operation of a fire risk management system for grenfell town and the other properties that it managed on behalf of the council

00:05:03 on behalf of the council we appreciate that at the time many residents saw the council of tmo as a single organization rather than two separate organizations this is entirely understandable for a

00:05:15 this is entirely understandable for a range of reasons one of those reasons being the fact that the council worked closely with the tmo but they were separate organizations that will need to be born in mind

00:05:26 that will need to be born in mind when analyzing the issues in this module

00:05:31 when considering the council's role in this module you will very largely be considering how the council monitored what the tma was doing on its behalf but dr lane is right when she says that

00:05:43 but dr lane is right when she says that she has found evidence of specific interventions made by the council regarding fire risk management i suggest that the most important example of this

00:05:54 example of this was the discussions in 2016 and 2017 about a stock-wide program to install self-closers on flat entrance stores i will say more about that later for the

00:06:06 i will say more about that later for the moment i want to focus on the council's monitoring of the tmo

00:06:12 the council's legal relationship with the tmo was governed by the modular management agreement this was a long complex document based on a template approved and issued by central

00:06:23 approved and issued by central government it set out what was delegated to tmo for it to manage on behalf of the council it also had provisions on how the council would monitor the tma's

00:06:34 council would monitor the tma's performance this was supplemented by a tmo monitoring procedure guide agreed between the council and the tmo these documents envisaged that the

00:06:47 these documents envisaged that the council would use a range of mechanisms to monitor the tma's performance in practice as we explained in some detail in our written opening the council did use a range of mechanisms to monitor the tmo's

00:07:00 mechanisms to monitor the tmo's performance i'm not going to go into all that detail now but i will highlight some key points about the council's monitoring the monitoring was done by officers and

00:07:11 the monitoring was done by officers and councillors but as you would expect more of it was done by officers the council failed to follow some of the procedures set out in the mma and tmo monitoring

00:07:23 set out in the mma and tmo monitoring procedure guide the most formal monitoring mechanism was the annual performance report in july and a mid-year report in november these

00:07:34 and a mid-year report in november these documents

00:07:35 documents were formally reported to the cabinet member who held the housing portfolio the tmo board and the council's housing and property scrutiny committee the reports drew together performance

00:07:46 the reports drew together performance data the outcomes of audits undertaken by the council's internal audit team and other information in the years before the fire the overall

00:07:57 in the years before the fire the overall assessment of the tmo in these reports was positive someone reading the reports would have been left with the impression that the tmo's performance did not give cause for concern

00:08:09 concern the reports always included a section on health and safety commentary in those sections tended to be positive but it is right to acknowledge that the sections on health and safety were brief

00:08:21 sections on health and safety were brief and tended not to cite evidence or empirical data in support of the points made in them on reflection the council considers

00:08:32 on reflection the council considers that the number of council officers devoted to monitoring the tmo was insufficient given the number of residents whose properties were managed by the

00:08:41 by the tmo and the scale and importance of the task

00:08:44 task delegated to the tmo

00:08:48 the tmo reported key performance indicators to the council but at no time did either of the two sets of kpis reported to the council measure the tmo's fire safety performance

00:09:01 tmo's fire safety performance the council acknowledges that there were aspects of fire safety performance which could have been measured empirically and which could therefore have been made the subject of a kpi

00:09:13 the subject of a kpi the council should have told the tmo that it needed to have in place some kpis to measure fire safety performance it failed to do so

00:09:29 mr chairman you and others may be wondering why the council didn't monitor the tmo more than it did i cannot point you to one single answer but there are

00:09:40 but there are a number of matters of background which taken together help to provide an explanation i will outline some of the key ones tmo was an independent organization

00:09:52 tmo was an independent organization owned by its members and accountable to its board residents elected to the board at all times made up a majority of the board members from 2002 onwards the tmo was an arms

00:10:05 from 2002 onwards the tmo was an arms length management organization when a tmo was set up in 1996 approximately 250 employees transferred from the council to the tmo in 2017

00:10:18 from the council to the tmo in 2017 tmo employed over 200 people including many in managerial positions those tmo managers were themselves monitoring the tmo's performance and reporting it to the tmo board

00:10:32 and reporting it to the tmo board the council officers involved in monitoring the tmo were conscious but it was an independent organization their work was not intended to duplicate the work of the tmo managers and board

00:10:46 the work of the tmo managers and board the agreement between the council and the tiemo did contain provisions that could be used to exert greater control over the tmo if it was underperforming and the

00:10:57 if it was underperforming and the council had shown a willingness to use them when necessary in 2008 the tmo agreed a deed of variation

00:11:04 variation which temporarily varied the tmo's obligations under the mma and an improvement plan was put in place this temporary process ended in 2010.

00:11:17 this temporary process ended in 2010. after that there were a number of indications that overall the tmo had healthy governance arrangements nevada's performance was improving

00:11:28 nevada's performance was improving in 2013 tmo management agreement full systems audit and a five-year review report both reached positive conclusions about the tmo

00:11:39 tmo there was required to be a test of opinion of the residents every five years

00:11:45 years the last one before the fire was in 2013 it was run by an external organization and the results were reported for tmo board

00:11:55 board they were informed that the number of residents who participated was the highest ever 86 percent of those who voted voted for the tmo to continue managing their homes

00:12:07 the tmo to continue managing their homes and the results were better than those of neighbouring boroughs and had also improved one of the tmo's aims was to increase its membership in the period 2012 to 2016 it did so by

00:12:21 in the period 2012 to 2016 it did so by almost 500 members per year at tmo's last annual general meeting before the fire over 95 of those who voted were in favor

00:12:32 over 95 of those who voted were in favor of the tmo continuing to manage their homes

00:12:37 i'm moving now to my second topic expert evidence and guidance documents in this module you have the benefit of expert evidence from two distinguished experts on fire

00:12:49 from two distinguished experts on fire risk assessment colin mr todd has been probably the country's most well-known expert on fire risk assessment for many years

00:13:00 assessment for many years his advice has been sought by a range of governmental and non-governmental organizations including the british standards institution the local government association

00:13:11 association the institution of fire engineers the fire industry association and the fire service college dr lane is the global fire safety engineering

00:13:22 is the global fire safety engineering technical lead at one of the world's leading engineering practices she has proved herself to be a highly competent expert in the course of this inquiry

00:13:32 inquiry one of the themes running through this module will be the fact that mr todd and dr lane

00:13:37 dr lane do not agree on all points similarly the guidance documents that existed before the fire do not all give identical advice there is disagreement between the

00:13:49 there is disagreement between the experts the panel will need to decide how best to resolve it but there is a second aspect to this prior to the fire there was one guidance document specifically designed

00:14:01 specifically designed for those managing purpose-built blocks of flats

00:14:04 of flats for local authorities this guidance was published by the local government association in 2011 following an extensive consultation exercise and input from the department for

00:14:16 and input from the department for communities and local government and the chief fire officers association it described itself as the more appropriate guide to use for purpose-built blocks of flats in

00:14:29 for purpose-built blocks of flats in 2013

00:14:30 2013 it was re-endorsed by dclg after the inquest into the lachnal house fire and was never revised or withdrawn before the grenfell tower fire

00:14:41 before the grenfell tower fire with the assistance of its assessors with social housing and local government expertise

00:14:47 expertise the panel will need to consider the extent to which it would have been reasonable for those involved in the management of grenfell tower to focus on the lga guide in preference

00:14:58 to focus on the lga guide in preference to other guidance documents industry practice is likely to be a relevant consideration when analyzing this issue

00:15:09 when analyzing this issue industry practice is likely also to be relevant to your consideration of the fire risk assessments carried out on grenfell tower in an ideal world

00:15:20 ideal world fire risk assessments will always be carried out by someone of a caliber of mr todd

00:15:25 mr todd or dr lane but this is not an ideal world

00:15:28 world and it was never intended but the task of carrying out fire risk assessments be reserved to qualified

00:15:35 qualified fire safety engineers for it to have been

00:15:39 been the government would have needed to pass legislation regulating a sector in fact the sector was and remains completely unregulated no qualifications are required by law no

00:15:52 no qualifications are required by law no training is required by law there was and is no bar whatsoever to anyone seeking to go into business as a fire risk assessor when one combines this absence of

00:16:05 when one combines this absence of regulatory framework with what was going on in the sector of a time one can see why mr todd says the following about carl stokes who carried out all the fire risk assessments on grenfell tower

00:16:18 assessments on grenfell tower his fras are amongst the most detailed of the many thousands of fras i've studied

00:16:24 studied within the fras there are many telltale indications that mr stokes is competent to carry out a suitable and sufficient fra in general and more specifically fras for high-rise

00:16:36 and more specifically fras for high-rise blocks to flaps such as grenfell tower in conclusion in my opinion car state was competent to carry out fras for grenfell tower taking into account his training skills

00:16:47 taking into account his training skills and qualifications in the practice of fire safety and the fras that he documented

00:16:55 there can be no doubt that at the time tmo genuinely believed that mr stokes was a competent fire risk assessor

00:17:02 assessor providing it with a professional service and that presumably explains why the tmo sought his advice on such a wide range of issues because mr stokes didn't just do fire risk

00:17:14 mr stokes didn't just do fire risk assessments for the tmo he also advised on issues that apply generally to the properties managed by the tmo

00:17:21 the tmo and on issues specific to grenfell tower

00:17:25 mr stokes fire risk assessments and advice for tmo will be central to many of the issues to be considered in this module the panel will need to consider whether

00:17:36 the panel will need to consider whether he was a competent fire risk assessor and whether his fire risk assessments for grenfell tower was suitable and sufficient but it will also need to consider whether anyone at the time

00:17:47 whether anyone at the time had reason to doubt his competence or the adequacy of his fire risk assessments and if so who

00:17:59 and if so who i now turn to the topic of residence with vulnerabilities in the event of fire

00:18:05 fire this is not a phrase used in a fire safety order but it is a helpful phrase used by dr lane to cover adults with cognitive impairment adults with sensory impairment adults

00:18:17 adults with sensory impairment adults with mobility impairment and children this is an important issue because the evidence suggests that a higher proportion of adult residents with such vulnerabilities

00:18:28 with such vulnerabilities died in the fire

00:18:31 here the different approaches recommended in the different guidance documents is particularly stark most of the guidance documents advised but specific measures be taken to

00:18:42 but specific measures be taken to protect

00:18:42 protect for example disabled residents but in contrast

00:18:47 contrast the guidance in the lga guide which was current at the time of fire stated that it is reasonable to expect that the occupants of a general needs block of flats

00:18:57 flats will reflect the diverse range of physical and mental capabilities of a general population as a whole it should be determined as to whether the number of disabled people is likely to

00:19:08 number of disabled people is likely to be different from atypical general needs block of flats it is usually

00:19:13 usually unrealistic to expect landlords and other responsible persons to have in place special arrangements such as personal emergency evacuation plans

00:19:24 plans the position at grenfell tower was that no resident had a personal emergency evacuation plan and none of the fire safety advice from tmo to residents

00:19:35 to residents contained advice tailored to the needs of persons who would be vulnerable in the event of fire

00:19:42 fire here again with the assistance of its assessors

00:19:45 assessors panel will need to consider the extent to which it would have been reasonable those involved in the management of grenfell tower to focus on the advice in the lga guide in preference to that given in other

00:19:57 in preference to that given in other guidance documents they will also be able to assist you with whether the occupancy profile of grenfell tower was different from other general needs blocks of flats

00:20:11 i now turn to the topic of flat entrance doors and self-closers phase one established but a major route for the spread of toxic smoke within grenfell tower

00:20:22 grenfell tower was from individual flats through flat entrance doors into communal areas at the time of the fire there were 120 flats in the town located on floors

00:20:34 located on floors 4 to 23. the flat entrance doors to 106 of those flats had been replaced in 2011. there are three main reasons why those

00:20:46 there are three main reasons why those comparatively new doors did not prevent the spread of smoke

00:20:51 smoke the first reason is that some of them were open rather than shut on the night of the fire because they did not have a working self-closing device all of them had been

00:21:02 self-closing device all of them had been fitted with self-closers when they were installed

00:21:05 installed but for various reasons some of them were no longer working or no longer present some six years later

00:21:12 later not all of the council's tower blocks were fitted with self-closers in 2011. one of those that was not was a dareta where fire broke out in october 2015.

00:21:24 where fire broke out in october 2015. after that fire self-closers were installed in a dare and consideration was given to introducing a self closer program through all of the properties managed by the tmo

00:21:37 properties managed by the tmo the council acknowledges that there should have been such a program in place before the grenfell tower fire in fact there had been a decision in principle

00:21:48 there had been a decision in principle to implement a program it had it had not begun to be rolled out the tmo and the council were both involved in the decision-making process

00:21:59 involved in the decision-making process where responsibility lies for the delay in implementation is something that can only be decided once you have heard from the relevant witnesses

00:22:08 witnesses from a tmo and the council the second reason why the doors did not prevent the spread of smoke is that testing done since the fire has

00:22:19 is that testing done since the fire has established that many of the doors were not compliant and did not resist fire and smoke for 30 minutes

00:22:25 minutes as they should have done under the contract between a tmo and its supplier mans masterdoor the purchase of the doors was a sizable procurement exercise

00:22:37 procurement exercise and the tmo were assisted in it by the london housing consortium and mr stokes sadly the problems with the fire performance of the doors were not limited to one

00:22:48 of the doors were not limited to one batch

00:22:49 batch or even one manufacturer subsequent events have revealed that these problems occurred on a national scale and were so serious

00:22:57 serious and widespread that in 2018 they resulted in major disruption to the supply of composite fire doors to the uk market

00:23:09 to the uk market the third reason why the doors did not prevent the spread of smoke should not be overlooked it is this the doors were never intended to withstand fire and smoke indefinitely

00:23:20 to withstand fire and smoke indefinitely nor were they required by law to do so

00:23:25 my final topic is complaints it is clear that a significant number of residents

00:23:32 residents of grenfell tower felt very strongly that it was not being managed as well as it could and should have been some of them were frustrated by how they were treated by the tmo

00:23:44 were treated by the tmo ryden and the council some of them complained some of those who complained were dissatisfied with how their complaints were handled and did not feel respected matters which

00:23:57 and did not feel respected matters which led to

00:23:57 led to high volumes of frustration and complaints included the power surges in 2013 issues which are raised during the refurbishment

00:24:08 refurbishment lifts breaking down and the gas riser works in 2016 and 2017. it is entirely understandable that residents were frustrated by these

00:24:19 residents were frustrated by these matters

00:24:20 matters and complained about them we say something about each of those individual matters in our written opening today i'm going to concentrate on the systems for addressing complaints

00:24:33 systems for addressing complaints the tmo and the council had separate complaint systems each organization's complaint system had three

00:24:41 three formal stages the two complaint systems were not

00:24:45 were not interlinked there was no right of appeal from the tmo complaint system to the council's complaint system the council's monitoring of complaints

00:24:56 the council's monitoring of complaints submitted by residents to the tmo was limited for example the tmo only formally reported a complaint's kpi to the council for two years ending in 2015.

00:25:09 for two years ending in 2015. in practice many grenfell tower related complaints were submitted in emails sent to recipients within both the tmo and the council

00:25:20 the tmo and the council what intended to happen was that the complaints were referred back to the tmo to address or left to the tmo to address the tmo was better placed to address matters of detail raised in complaints

00:25:32 matters of detail raised in complaints about services managed by the tmo we therefore consider that in general this approach made sense but it also had a weakness

00:25:43 but it also had a weakness the weakness was that it increased the risk of patterns in complaints about the tmo

00:25:49 tmo or its services being missed by the council

00:25:52 council in its monitoring of the tmo this brings me to the end of the themes in module 3 that i wish to address you on today as

00:26:04 that i wish to address you on today as you are aware we cover a wider range of topics in our written opening statement and also analyze the evidence in more detail there that evidence will be added to by the evidence of witnesses due to be called

00:26:16 evidence of witnesses due to be called in

00:26:16 in april may june and july in our closing statement

00:26:21 statement we will take account of that evidence and set out the council's position in further detail and in accordance with the council's commitment to canada thank you that concludes my opening

00:26:33 thank you that concludes my opening statement well thank you very much indeed mr maxwell scott

00:26:41 at this point we would expect to hear from

00:26:44 from mr agarose on behalf of the tenant management organization he was due to

00:26:51 due to appear at quarter past three and i don't know whether he's actually i'm here sir oh mr gross good afternoon good afternoon

00:27:01 afternoon is it convenient to you to uh make a statement at this point yes if we may please sir um we would normally have a break sometime during the afternoon you're currently

00:27:13 during the afternoon you're currently scheduled

00:27:14 scheduled to have an r if you want to use it um would you like to see how you're going

00:27:22 going round about 3 15. and if you reach a point

00:27:26 point broadly speaking somewhere around between 3 15 and 3 30 when it would be convenient to take a break perhaps you could let me know yes thank you very much sam well thank you very much you can obviously hear me and see me and

00:27:38 you can obviously hear me and see me and i can see you all and it's good and it just remains therefore for me to invite you to make your statement so mr chairman panel members we too have

00:27:49 so mr chairman panel members we too have submitted a near 50-page written opening statement and these oral submissions represent an abbreviated version of that statement and they develop themes which are set out there

00:28:01 out there and so we invite the inquiry to refer to those written submissions when considering the detail of any oral submissions made here so may i say at the outset that the tmo

00:28:12 tmo and all that worked for it acknowledged the immense tragedy of the grenfell tower fire and nothing in these submissions is intended to diminish

00:28:21 diminish or detract from that tragedy all those who give evidence on behalf of tmo

00:28:27 tmo and there will be many of them in module three sir continue to express their profound sympathies and condolences to the bereaved survivors and residents so

00:28:39 and residents so topic one of module three is primarily concerned with the tmo systems for communication with residents consultation concerning the refurbishment residents complaints regarding fire

00:28:51 residents complaints regarding fire safety risks doors and the quality of workmanship during the refurbishment and the response and degree of engagement i think as you put it of the tmo

00:29:01 tmo and rbkc to those complaints so you'll hear first from former residents of grenfell tower and then from witnesses from the tmo and rbkc at varying levels of seniority

00:29:14 rbkc at varying levels of seniority regarding the systems policies and procedures each body had implemented to deal with residents complaints and their response to those complaints as well as the management of the

00:29:25 as well as the management of the building

00:29:26 building so you're also going to hear evidence about the governance arrangements between rbkc and the tmo and in particular how they worked during the refurbishment and to that end you will hear from

00:29:38 and to that end you will hear from senior representatives from tmo and rbkc so we acknowledge that when considering the issue of complaints and concerns the inquiry's primary focus will be on

00:29:50 the inquiry's primary focus will be on matters causally connected with the fire but the inquiry will also consider the way in which complaints more broadly were managed and so this being the case the tmo intends to briefly address some of the

00:30:02 intends to briefly address some of the wider issues touching on that on that topic here for me at the outset and it's right that we say this sir the tmo acknowledges that the relationship with some residents were

00:30:13 relationship with some residents were sometimes

00:30:14 sometimes strained and difficult both before and during the refurbishment and we have no doubt that you will scrutinize the reasons

00:30:23 reasons for this however so this is not to say that all residents were always at odds with the tmo and the inquiry may wish to consider whether views expressed by some more vociferous residents were truly

00:30:35 more vociferous residents were truly representative of the views of a majority of residents but so can we say in a nutshell that the tma doesn't accept that it ever adopted a dismissive attitude towards residents

00:30:48 a dismissive attitude towards residents or indeed to their complaints and concerns

00:30:53 so we suggest that when you look at the nature of the relationship between tmo and the residents during the relevant period that the inquiry should have particular regard to the following three

00:31:04 particular regard to the following three factors

00:31:06 factors so first there have been vehement opposition from some residents at grenfell tower to the calc

00:31:13 calc project and forgive the abbreviation but it's for the sake of time from its very inception and strong criticism of rbkc in particular and much of this criticism was voiced in

00:31:24 and much of this criticism was voiced in the grenfell action group blog which i'm going to refer to as the gag blog sir going on so the inquiry may consider whether this soured the relationship between some tenants and the tmo and rbkc

00:31:38 tenants and the tmo and rbkc but also indeed whether the strong opposition was representative of the lancaster west community as a whole given that the calc project was to build a much needed school and leisure facilities for children in

00:31:50 and leisure facilities for children in the borough second the tmo finally took over in 2014 from the estate management board referred to as the emb for the lancaster west

00:32:00 west estate the emb was a tenant-led organization separate too and pre-dating with tmo which was first registered in 1993. there came a point when the enb

00:32:12 in 1993. there came a point when the enb was not functioning well and there was a strongly held view that its members were unaware of what was expected of them although it's right to say that residents voted at one point to retain

00:32:23 residents voted at one point to retain the emb

00:32:24 the emb concerns remained about its performance and rbkc worked on an improvement plan a step which was prescribed by the mma this failed to result in progress and

00:32:36 this failed to result in progress and rbkc eventually terminated the contractual relationship with emb in 2014 despite a widespread perception of mismanagement

00:32:47 a widespread perception of mismanagement and so there there are various emails which relate to this some residents thought it had been shut down and this is a quote in an underhand

00:32:56 underhand and duplicitous manner by rbkc so of course it's a matter for the inquiry but we would submit that this probably created a breakdown in trust between the tmo rbkc and some residents

00:33:08 between the tmo rbkc and some residents and impaired tmo achieving a good relationship with some tenants going forward so third when considering the nature and volume of complaints made by residents during the refurbishment it should be kept in mind

00:33:21 refurbishment it should be kept in mind that for residents continuing to live in situ

00:33:25 situ when major works were occurring both inside and outside their flats can only have been

00:33:30 have been extremely difficult the construction work was intrusive and noisy and one lift was often unavailable to residents because it was being used by builders and so against this background

00:33:42 builders and so against this background it's possibly unsurprising that there was an

00:33:45 was an increased number of complaints and expressions of dissatisfaction from residents

00:33:51 residents indeed consideration was given to the possibility of re-housing residents during the refurbishment but this was not

00:33:58 not for practicable or desirable indeed some residents had concerns that if they left the area they would be re-housed in an unfamiliar location would not be able to return while such

00:34:11 would not be able to return while such concerns

00:34:12 concerns were certainly baseless they are indicative of the level of mistrust that existed between some residents and the tmo rbkc

00:34:22 so we have an eye to the evidence that you will be hearing in in this module and one of the um one of the parts of evidence will be the in relation to fire related complaints will be the contents of the grenfell

00:34:34 will be the contents of the grenfell action group blog dated the 20th of november 2016. just to say a couple of things about the blog in fact the language often used in the blog

00:34:45 the blog was indicative of the levels of mistrust that have built up in the minds of some residents towards the tmo what we on behalf of the tmo submits is the inquiry should be cautious about the

00:34:56 the inquiry should be cautious about the contents of the gag blog because it contained a highly personalized narrative including a number of personal attacks on our tmo and rbkc employees and because indeed the authors never

00:35:09 and because indeed the authors never identify themselves the blog often uses the word we in connection with the residents of grenfell tower and so far as the tmo is concerned it appears to be the work of at most a handful of authors

00:35:23 at most a handful of authors so we summarize one past the blog and the november blog said and this is a quote we've abbreviated the question and i hope not unfairly so it said that the tmo was an irresponsible mini mafia

00:35:36 the tmo was an irresponsible mini mafia and only an incident that results in serious loss of life to kctmo residents will allow the external scrutiny to occur

00:35:43 occur that will shine a light on the practices that characterize the malign governance of this non-functioning organization so what we say about that is this is

00:35:54 so what we say about that is this is that despite the appearance of prophecy and we acknowledge that the writers were certainly not predicting a cladding fire of the type that occurred on the 14th of june 2017.

00:36:07 occurred on the 14th of june 2017. so far as the tmo is aware no witness or organization connected with this inquiry predicted such a fire at grenfell tower despite the fact that similar cladding

00:36:19 despite the fact that similar cladding fires had

00:36:20 fires had apparently occurred abroad and about which you have heard evidence in phase one

00:36:25 one so ultimately it's a matter for you but we would submit that the evidence that you've heard in previous modules bears out the fire was not caused by the malign

00:36:33 malign governance of a non-functioning organization i referrable to rather tmo arose from the widespread and deep rooted blindness within the

00:36:44 and deep rooted blindness within the private and public sector to the inherent dangers of materials regularly used in the building industry or even worse by deception for commercial gain on the past of those

00:36:56 for commercial gain on the past of those companies that marketed and supplied cladding and insulation so the evidence inquiries heard in module two thus far was it submitted truly shocking and shows

00:37:08 it submitted truly shocking and shows that even those with with responsibility for safety certification did not uncover the combustible nature of the products used in

00:37:16 used in the refurbishment so a measure of the extent of the blindness as i've referred to it is the fact that some 2000 buildings across the uk had been clad in and insulated with

00:37:30 had been clad in and insulated with similarly combustible materials although the fire happened at grenfell tower it could as easily have happened another building

00:37:38 building clad in combustible materials and so it's no doubt for this reason among others the fire marshals maintain vigils

00:37:45 vigils at numerous buildings even to this day so the debates about how to solve this systemic and far-reaching problem continues even now between the

00:37:56 continues even now between the government the construction industry and building managers and their tenants including who will bear the cost for removal and replacement of cladding so when considering the role of

00:38:07 cladding so when considering the role of the tma we invite the inquiry new panel members to bear this in mind that the tma was an organization staffed by non-construction professionals with a background in social housing

00:38:19 background in social housing this was a design and build contract and the tma relied on various specialists and industry professionals throughout the refurbishment project and its reliance on professional

00:38:30 and its reliance on professional advisors represented the norm for contract procurement and capital works within the public sector

00:38:38 sector so while and if i may say rightly as you have put it and i hope i quote you correctly that the tmo was an educated client it operated only with the reasonable

00:38:49 it operated only with the reasonable foresight of a social housing manager and not and in not foreseeing such a terrible tragedy it was no different to hundreds of other organizations across the uk the question

00:39:02 organizations across the uk the question must be whether the tmo is to be judged differently to organizations in a similar position

00:39:10 so dr lane particularly criticizes the tmo for not uncovering the risk the refurbishment pose following warnings arising from two fires the lachnal house fire in 2009

00:39:21 fire in 2009 and the shepherds caught fire in 2016 and the warning letter from lf epa as a result of the shepherd's court fire in april 2017

00:39:33 april 2017 so the tmo invites inquiry to consider whether it alone should have been expected to see through the deceptions practiced by the manufacturers of the cladding and insulation

00:39:44 insulation especially when certifying bodies such as the bre and bba approve their suitability for use in construction and or provide a misleading certificates

00:39:56 and or provide a misleading certificates which inspired trust and materials used on the tower so hundreds of other building owners or managing organizations did not untangle this subterfuge even when like

00:40:08 untangle this subterfuge even when like the tmo

00:40:09 the tmo they were advised by teams of professionals so i'm going to deal now with the issue of resident engagement and may we say this that the tma put considerable effort and resources into

00:40:20 considerable effort and resources into resident engagement which we define as the drive to ensure residents were involved in decisions surrounding the management of their homes

00:40:29 homes the tmo was and was designed to be a resident-led organization and its constitution made it a requirement the board consisted of a majority of residents including the chair

00:40:41 residents including the chair from the time that robert black was appointed chief executive in 2009 the tmo sought to stimulate meaningful resident engagement recognizing that it had fallen to a low

00:40:52 recognizing that it had fallen to a low level especially following the demise of the emb in 2014. initially a door knocking exercise was carried out across all properties in the tmo estate to

00:41:05 properties in the tmo estate to understand where what resident's main issue and concerns were

00:41:09 were following this the tmo sought to increase resident membership in a number of ways for example by holding road shows

00:41:16 shows annual conferences the senior citizens annual party the youth engagement project and the tmo live

00:41:24 live up your game projects it also promoted the creation of residents associations which numbered something like 53 across the borough with 10 alone set up in 2015 2016.

00:41:38 set up in 2015 2016. so all of this work was done by a dedicated resident engagement team which included a resident engagement manager

00:41:46 manager so we appreciate the reference to figures that demonstrate level levels of resident engagement may not may not be helpful without context which we're not going to provide fully

00:41:58 which we're not going to provide fully here it's in it's in the written submissions but the drive to increase resident

00:42:01 resident engagement certainly successful an example is increase increase in turnout for the tmo board member elections as well as increased participation in

00:42:12 as well as increased participation in the agm

00:42:13 the agm the 2016 agm 96 of the over 1200 people who voted

00:42:19 who voted were in favor of tmo continuing to manage their properties possibly the most telling measure of resident engagement and indeed of resident improv approval was a test of opinion

00:42:31 was a test of opinion which was carried out every five years where tmo members were asked if they wanted the tmo to continue to manage their homes the most recent test of opinion before the fire

00:42:44 test of opinion before the fire involved an increase in participation of 122

00:42:48 122 and there was an overwhelming vote in favor of the tmo continuing in its management role so in in very real terms if it had been the resident's wish the tmo could

00:42:59 wish the tmo could almost literally have been voted out of existence or other management arrangements put in place so resident engagement was monitored by rbkc and it received a substantial assurance result in the minutes

00:43:11 assurance result in the minutes of the hra performance meeting in february 2017. turning now to the question of resident consultation for the refurbishment

00:43:23 consultation for the refurbishment so we anticipate you will hear that the tmo saw actively to consult with residents concerning the refurbishment from the earliest stages this included giving residents a choice about how they would like to be

00:43:35 about how they would like to be consulted

00:43:37 consulted consultation on design proposals for the refurbishment took place in 2012 and 2013 in particular in many different ways including we list these here so they're listed in the submissions

00:43:49 they're listed in the submissions through meetings in both the daytime and the evening to accommodate as many residents as possible newsletters which invited residents to road shows and consultations

00:44:00 road shows and consultations and questionnaires where residents were asked about a number of matters including

00:44:04 including their priorities for windows i whether they should be self cleaning and options for the operation of the windows i pivot reversible sliding or tilt and

00:44:15 pivot reversible sliding or tilt and turn

00:44:17 turn where the grenfelt would benefit from thermal insulation cladding and so there was a high yes vote for this but no clear opinion was expressed about the color or type of cladding where the homes would

00:44:28 type of cladding where the homes would benefit from new individual boilers which

00:44:31 which could be controlled by each flat individually and again there was a high yes vote for this residents were also kept up to date via newsletters for example there were three in 2013

00:44:43 for example there were three in 2013 which advised of any changes to the plan submitted

00:44:47 submitted and reported on the results of surveys etc

00:44:50 etc and so we've referred to those in detail in the written submissions and in addition to the above ryden's the principal contractor hosted coffee mornings and arranged home visits from their resident liaison

00:45:02 visits from their resident liaison officer linda prentice so throughout its consultation process the tno sought to obtain as many resident views as possible

00:45:11 possible on the refurbishment and moreover as an example of how the tmo listened to resident views it did adapt the project after listening to resonance for example

00:45:23 after listening to resonance for example it changed the design of the windows when it became apparent that the initial proposals would result in more intrusive work

00:45:30 work being done internally to flat it recognized and engaged with a new residence compact when it was suggested that residents concerns were not being heard

00:45:40 heard properly by the existing lancaster west residents association and it eventually moved the hiu after residents challenged tmo about its revised position

00:45:51 revised position and we'll go into that in a little a little bit more detail later so dealing now with complaints and service inquiries the tmo certainly had in place systems

00:46:03 the tmo certainly had in place systems for dealing with residents concerns and complaints including those concerned with the refurbishment however and we acknowledge this the contents

00:46:14 contents the content of many of the statements from residents witnesses and the tmo evidence may be difficult for the inquiry always to

00:46:24 to reconcile the picture painted in those statements is sometimes very different of course that will be a matter for the inquiry to consider carefully in module three

00:46:36 module three however complaints handling was always a priority for the tmo and its performance was monitored both internally and externally internally by the operations team the

00:46:47 internally by the operations team the senior management team the executive team and the board and externally by rbkc the tmos complaints policy required it to apply the housing ombudsman

00:46:59 to apply the housing ombudsman principles for effective complaint handling the portfolio was overseen on a day-to-day basis by the tmos policy and improvement manager and there was a dedicated complaints manager and two

00:47:11 dedicated complaints manager and two complaints officers the complaint team had monthly meetings where all issues were discussed and a quarterly report on complaints was prepared

00:47:20 prepared containing kpis and statistics the complaints policy distinguished between a complaint and an inquiry an inquiry was defined as

00:47:31 and an inquiry an inquiry was defined as an i hope the quote is accurate a first time request for information advice or foreign action to be undertaken eeg estate cleaning not undertaken estate licensing not working or a repair

00:47:44 estate licensing not working or a repair request

00:47:46 request on a practical level an inquiry would be passed on by the staff member receiving it to either the customer service center or directly to the relevant team for action

00:47:57 action the intention of the tmo was always to resolve inquiries as soon as possible without them escalating into formal complaints and so of course we've seen some of the submissions made by the bsrs but we

00:48:09 submissions made by the bsrs but we would say this this wasn't in an attempt to bypass or avoid formal complaints but because

00:48:15 because informal resolution was always preferable by contrast the complaint was defined as an expression of dissatisfaction about a kc tmo

00:48:26 kc tmo service or a service provided by a kc tmo contractor not resolved immediately to the customer satisfaction about the level quality or nature of a

00:48:37 about the level quality or nature of a service which the customer feels should have been provided the tmo publicized the complaints procedure widely to residents on its website

00:48:46 website on its website at road shows in the link magazine

00:48:51 magazine and through leaflets and posters in the housing offices and against this background so we invited the inquiry to consider whether some of the bsr's contention i.e that the complaints policy was not

00:49:03 i.e that the complaints policy was not widely known or understood as correct residents with consent with concerns or complaints could contact the tmo by a number of means including emailing a dedicated dedicated complaints email address

00:49:16 dedicated complaints email address calling the customer service center or visiting the local housing office complaints and inquiries were logged and progressed through the w-2 system initially and from 2016

00:49:27 system initially and from 2016 through the crm system a complaint would first be assigned to the complaint's team and then reassigned to the relevant tmo for its tmo team for example repairs

00:49:38 for its tmo team for example repairs direct

00:49:39 direct but the complaints team would always monitor outstanding complaints to ensure compliance including time limits etc and would use an interactive complaints dashboard to monitor this

00:49:53 the complaints policy set out a three-stage process stage one involved an investigation by the manager of the relevant service area and if a resident was not happy with the

00:50:04 and if a resident was not happy with the outcome of the investigation they could escalate their complaint to stage two stage two involved investigation by the head of service residents who were still dissatisfied at

00:50:15 residents who were still dissatisfied at stage two could request a stage three review which was the final stage of the procedure

00:50:20 procedure and involved a formal panel meeting comprising of an independent board member

00:50:26 member or a council appointed board member a resident board member and an executive director

00:50:32 director a board member chaired the panel and in the later years the complainant could attend the panel in person dissatisfied with the outcome of the stage three review the resident could appeal to the housing ombudsman

00:50:45 appeal to the housing ombudsman complaints performance was monitored using a set of kpis and was reported to the executive team and the operations committee

00:50:53 committee the complaints on the procedure was subject to an internal audit by the rb case

00:50:57 case by an rbkc rbkc team and rbkc maintained independent oversight

00:51:05 oversight of complaints so can we touch on now a few complaints arising from the refurbishment and some particular complaints but make this point at the outset that it's important to note that the primary

00:51:16 it's important to note that the primary mechanism

00:51:18 mechanism for raising contained concerns during the refurbishment was through ryden we had a permanent resident liaison officer rrlo based in the tower to deal with any day-to-day issues

00:51:32 the rlo details including when they were available will communicate in each newsletter there was also ryden's email address by which residents could express their written concerns to ryden claire williams from whom

00:51:45 to ryden claire williams from whom you've heard and from whom you will hear from the tmo also liaised closely with arden's

00:51:51 arden's with ryden's rlo both during and after the works

00:51:55 the works and always sought to ensure that residents concerns and requests for repairs were dealt with the tmo and ryden also held regular liaison meetings to discuss concerns and housing management issues

00:52:07 concerns and housing management issues impacting

00:52:07 impacting upon residents

00:52:11 so dealing with formal complaints there were seven formal complaints from four

00:52:17 four separate residents during the period of the refurbishment of these seven complaints four was four were submitted by the same resident four not upheld two were upheld

00:52:31 four not upheld two were upheld and one was partially upheld so may we say straight away that we recognize

00:52:37 recognize that this simple figure this simple number does not fully capture the level of concern expressed by residents about the refurbishment and their concerns were often conveyed

00:52:48 and their concerns were often conveyed in different ways but what we do say sir is it demonstrates there was a system in place which residents were able to use and indeed the outcome was not always in

00:52:59 and indeed the outcome was not always in the tmo's favor

00:53:03 we deal now with a the history of a particular formal complaint made to tmo and so it's this in december 2015 edward defan made a complaint relating to the refurbishment

00:53:14 refurbishment works it was heard at stage one by peter madison

00:53:17 madison and not upheld mr dufan escalated his complaint to stage two where it was considered by mr madison's line manager sasha jevons the director of operations

00:53:29 jevons the director of operations she concluded the handling of the matter of the matters mr de farm was complaining about had been appropriate and did not uphold the complaint mr dufan escalated his complaint to stage

00:53:41 dufan escalated his complaint to stage through it was and it was heard by a stage three panel in february 2016 and there was a decision not a unanimous decision not to uphold it

00:53:52 decision not to uphold it as was his right mr defan took his complaint to the independent housing ombudsman and the ombudsman also concluded that there have been no administration no mal administration

00:54:03 no administration no mal administration and no service failure so you you have the ombudsman's report and it's it's a long document but in summary the the conclusion was the tmo had acted reasonably

00:54:15 reasonably rearranging commencement dates for works and there had been no malice no mal administration so turning now to consideration of complaints that didn't go through the complaints procedure there

00:54:28 through the complaints procedure there was

00:54:28 was as i've said earlier an existing residence association for grenfell tower and the lancaster west estate which had been established in 2015.

00:54:40 which had been established in 2015. some residents were unhappy about the way in which it operated and wished to start a separate organization and as a result the residents

00:54:47 residents compact came into existence in 2015. at a residence compact meeting in june 2015 it was suggested by members that the tmo and against others as a quote had

00:54:59 and against others as a quote had harassed lied and intimidated residents over the duration of the works at the meeting the tmo gave a commitment that any specific allegations would be investigated in accordance with the

00:55:11 investigated in accordance with the complaints procedure and appropriate action taken to resolve the matter a petition signed by 51 residents was presented to the joint tmo rbkc meeting on the 2nd of december

00:55:25 tmo rbkc meeting on the 2nd of december 2015

00:55:26 2015 asking the chairman of the housing and property scrutiny committee to undertake and again we quote sir urgent scrutiny of the tmo and ryden's management of the refurbishment project

00:55:37 management of the refurbishment project currently underway at grenfell tower our day-to-day concerns are belittled and sidelined while we recognize that once completed the towel will at

00:55:48 that once completed the towel will at long last be fit for the 21st century during this process we have had to endure living conditions that time have been intolerable

00:55:58 and so of course we we accepted the beginning of the submissions that the the conditions for the residents must have been extremely difficult and nobody is doubting that

00:56:09 nobody is doubting that following the receipt of the petition the tmo undertook a door knocking exercise

00:56:13 exercise and spoke to 77 of the 120 households in grenfell tower by contrast the petition the door knocking exercise disclosed a high level of satisfaction concerning the refurbishment

00:56:25 refurbishment and no resident raise any commissions any issues relating to bullying or harassment mr davan made a speech to the housing and property scrutiny committee on the 6th of january 2016

00:56:37 committee on the 6th of january 2016 when he raised similar concerns to those in the petition and in the light of this the tmo convened a formal inquiry and root and review to examine the ground floor project

00:56:48 ground floor project overall while the works were still occurring

00:56:51 occurring the panel chosen to conduct the inquiry was chosen to be representative and unbiased and included a number of resident board members the review had

00:57:02 resident board members the review had wide terms of reference and examined issues such as resident consultation and engagement the position of the hiu in the hallways allegations of threats lies in intimidation

00:57:13 intimidation response to complaints quality of work and site management and compensation and there were presentations and a tour of grenfell tower the group recognized that there were

00:57:24 the group recognized that there were significant challenges with the project and acknowledged that residents would have experienced inconvenience due to the nature of the construction however it concluded that there had been

00:57:35 however it concluded that there had been comprehensive consultation with residents including over hius and the tmo had responded adequately to complaints and it concluded that controls were sufficient to manage a construction

00:57:46 sufficient to manage a construction project of this size and nature but it's right to say sir and they're indeed they're set out in detail the group did make certain recommendations regarding the need for changes for future projects

00:57:58 future projects an example being the recording of names of residents who attended consultation meetings so dealing lastly with one other master in relation to complaints and if i may

00:58:09 in relation to complaints and if i may i'll ask for a break because i think it follows naturally as according to where we are um these are complaints which were made by and on behalf of the grenfell tower

00:58:20 and on behalf of the grenfell tower leaseholders association which we abbreviate abbreviate to gtla

00:58:27 an example of a complaint raised by the gtla is for mr tunderu he who in april 7th 2017 sent an email to tmo and rbkc requesting an

00:58:38 to tmo and rbkc requesting an independent expert investigate the gas works at grenfell tower the background of this is the tower's gas supply was historically introduced by four risers one of which ruptured and

00:58:51 by four risers one of which ruptured and had to be replaced this was done by the statutory gas utility company trio pursuant to its statutory powers while consulted neither tmo nor rbkc had

00:59:03 while consulted neither tmo nor rbkc had final

00:59:03 final say over how when and where the work was done

00:59:07 done and residents as so you will hear became understandably concerned about the work particularly the new gas pipe was left exposed in the stairway in response to the

00:59:20 the stairway in response to the complaint the tmo instructed carl stokes to visit the tower and inspect the newly installed gas riser and laterals he visited the tower in january 17 and published a report which was provided to

00:59:32 published a report which was provided to trio

00:59:33 trio with eight recommendations relating to fire stopping gas safety trio in turn provided an assurance to the tmo that the newly installed lateral pipe work would be boxing for ventilation purposes

00:59:45 would be boxing for ventilation purposes and holes sealed where they were not needed for ventilation and so this was work which was ongoing at the time of the fire and we have no doubt that the inquiry will look at this issue extremely

00:59:56 will look at this issue extremely carefully

00:59:58 carefully so the inquiry will also be hearing from the president david collins and it's accepted and recognized that mr collins also raised a number of concerns and complaints with tmo at different times during the refurbishment on behalf of himself and

01:00:11 refurbishment on behalf of himself and other ra

01:00:12 other ra other residents

01:00:17 mr collins stated after the fire i in his statement that a lack of engagement again we quote so hopefully accurately lack of engagement with the tmo and their agents meant that residents were never

01:00:28 never that residents never learned in detail about the cladding materials or other aspects of the project which were a risk to resident safety and well-being he predicted i said this before the fire

01:00:39 he predicted i said this before the fire bad outcome for the tmo for resident engagement was not more effective and monitored externally so the tmo accepts the inquiry will give careful consideration of the complaints

01:00:50 careful consideration of the complaints but made by mr collins and we'll examine whether they were dealt with appropriately but we would say this in relation to any complaint raised by him regarding consultation over the cladding the residents were con were consulted

01:01:02 the residents were con were consulted about the cladding albeit not about its fire retardant properties as it was legitimately assumed by the tmo that its professional advisors had given proper consideration to

01:01:13 had given proper consideration to compliance with safety standards

01:01:18 following the works residents were spoken to directly to ascertain what defects remained outstanding by ryden's rlo and by claire williams the defects in the main said to be

01:01:29 the defects in the main said to be outstanding which windows and kitchen fans are closely consistent with the defects list compiled by ryden and so you know that the defects period expired on the 4th of july 2017 i.e after the fire

01:01:43 2017 i.e after the fire so of course there's a matter for the inquiry we acknowledge the strength of the evidence from the the bsrs but the the timo submits in overall terms complaints and concerns were

01:01:52 were dealt with and responded to in an appropriate and generally timely manner in addition to the complaints process there was scrutiny by a board a panel of

01:02:03 there was scrutiny by a board a panel of board members and oversight by rbkc the fact that some complaints which were formally escalated up were eventually upheld it still illustrates the point that this was a

01:02:14 illustrates the point that this was a process and system in place which was transparent and effective to a degree at least so i'm moving on now to the topics in two and three

01:02:25 two and three and i'm conscious of having been going for about half an hour so if this would be suitable for the for you and the panel members to have a break it would be suitable for me good thank you very much well

01:02:36 for me good thank you very much well you've got a little bit further to go haven't you anyway i have i have a bit further site can i just so for all those are listening i would anticipate the remainder of my oral submissions will be about half an hour

01:02:45 hour yes well i think it probably would be convenient to have a break at this point and

01:02:50 and um if we came back at 25 to 4 that would still mean we'd finish roughly within time thank you very much thank you very much we'll break now we'll

01:03:01 much we'll break now we'll resume at 25 to four then please thank you thank you

01:20:36 welcome back everyone uh i'm going to invite mr agaros to continue his opening statement so thank you very much dealing now with topics two and three

01:20:47 topics two and three topic two will consider the tmo and rbk's obligations under the regulatory reform

01:20:52 reform fire safety order 2005 and their compliance with those obligations topic three will consider the active and passive fire safety measures inside grenfell tower

01:21:04 measures inside grenfell tower and the management and maintenance of the building as it's likely that the inquiry will invite witnesses giving evidence in topics two and three to address propositions and opinions expressed by dr lane in her recent reports

01:21:17 dr lane in her recent reports for the purposes of this opening the tma will focus on some of her key findings as well as giving due regard to the reports prepared by other experts commissioned by the inquiry such as colin todd

01:21:28 colin todd and roger haukins excuse me we make the following general observations about dr lane's phase 2 report

01:21:36 report it's only recently been served and it's long dense and complex dr lane along with numerous assistants has carried out a full forensic audit of the tmos fire risk assessments

01:21:47 audit of the tmos fire risk assessments and action plans measuring their performance measuring its performance against legislation statutory instruments and sector guidance a report has been produced with

01:21:58 guidance a report has been produced with the benefit of extensive time resources and importantly with the full benefit of hindsight separately her report has been so piecemeal within the last month

01:22:09 piecemeal within the last month without its conclusion chapter leaving the tmo with we respectfully submit limited time to address it fully in this opening statement

01:22:18 statement and so this has been compounded by the fact that tmo is no longer an active organization and therefore to the extent necessary the tmo may address further issues

01:22:29 issues in its closing state for modules one two and three

01:22:36 so when the inquiry examines what tmo employees did and did not do in relation to module three topics it should bear in mind that when devising its fire strategy no individual at tmo nor apparently any

01:22:48 no individual at tmo nor apparently any of its professional advisors had an inkling

01:22:51 inkling the tower would ever be engulfed entirely in flames from the outside which then rapidly infiltrated back into each flat

01:22:59 each flat and finally as you have observed sir completely overwhelmed the active and passive fire measures

01:23:06 measures whatever their state of repair rather when devising and maintaining the active and passive fire measures tmo's expectation was that at worst there would be a fire in one flat

01:23:18 there would be a fire in one flat which would cause the occupant of that flat to leave but that all other resins would be protected in their own flats by compartmentation without the need for simultaneous building wide evacuation

01:23:31 building wide evacuation the submitted inquiry should assess the tmo and its employees actions in the light of what was reasonably foreseeable to them at the time and not with the bright illumination of hindsight

01:23:43 hindsight so next the tmo also considers that dr lane is sometimes over harsh in her criticisms of janice ray in particular this may be because she does not always accurately describe

01:23:54 accurately describe janice ray's role at the tmo and sometimes appears to fundamentally misunderstand it janice ray was employed as the health and safety facilities manager which was an occupational health and

01:24:06 which was an occupational health and safety role her her remit was not just grenfell tower but the whole of the property portfolio managed by tmo which included 19 tower blocks and over 10 000

01:24:17 10 000 properties one of the things said by dr lane as janice ray had unique responsibility for ensuring active and passive fire measures were properly maintained at the tower when in fact a large part of this fell

01:24:29 when in fact a large part of this fell to the contracts management team and so in this regard and of course as a matter for you we know the inquiry is not proposing to hear live evidence from an individual from within the contracts management team

01:24:40 management team and we respectfully invite you to consider doing so the tmo submits that janice ray was a hard-working and dedicated health and safety professional who acted in an organized and efficient

01:24:53 who acted in an organized and efficient manner

01:24:54 manner always seeking to gain full visibility of the health safety and fire issues occurring within the tmo and then to address them expeditiously with the resources available to her and

01:25:05 with the resources available to her and her team

01:25:07 her team further she was not and never purported to be a specialist in fire safety or herself

01:25:13 herself a fire risk assessor and while of course she was involved in producing the fire safety strategy this was in consultation with other professionals and when it was when it came to the

01:25:24 and when it was when it came to the production of the fire risk assessments it was necessary for her and the tmo to engage and rely on professional fire risk assessors such as salvers consulting limited

01:25:35 salvers consulting limited and carl stokes associated limited dr lane also makes numerous criticisms of carl stokes and it's for the inquiry to decide whether these justified or not

01:25:47 to decide whether these justified or not but the tmo observes that many of her criticisms run contrary to the views of colin todd who is

01:25:53 is an expert in fire risk assessment which dr lane although eminent is not indeed mr cod mr todd says of carl stokes

01:26:04 mr cod mr todd says of carl stokes wormists are stokes to apply for registration by by the ife on their register of fire risk assessors i would have no hesitation on the basis of his training experience and examination of his fras in recommending him

01:26:19 of his fras in recommending him so further we submit that when criticizing the tmo dr lane does not always give proper account to the practical realities for those

01:26:27 those managing social housing within budgetary constraints in the public sector this is not of course to say that any decision taken by tmo put costs before safety but that tmo

01:26:39 tmo put costs before safety but that tmo never had the means to develop its fire safety strategy in all of the ways dr lane suggests indeed against a matter for you we consider it this unfortunate that the

01:26:50 consider it this unfortunate that the inquiry's main expert does not obtain any evidence of the practice of comparable social social housing managers when making judgments about the tmo

01:27:01 judgments about the tmo if the inquiry is to make significant findings about the tmos performance we submit this should be in the light of what other social housing managers did to develop a fire

01:27:11 fire safety strategy

01:27:16 turning now to the tmo system for fire risk management and the suitability and competence of karl stones the tmo accepts it was the responsible person

01:27:26 person for the purposes of article 3 of the regulatory reform fire safety order 2005 and had responsibility for identifying the general fire precautions for premises under its

01:27:37 precautions for premises under its control

01:27:39 control there may well have been other persons who also fulfilled the role of responsible person but the tmx turmoil accepts its own primary responsibility this submitted the tmo had a fire safety

01:27:51 this submitted the tmo had a fire safety policy and strategy which was appropriate to its nature and size this policy and safety strategy have been developed in consultation with lfb and rbe kc at least to an extent

01:28:04 lfb and rbe kc at least to an extent indeed dr lane herself considers that the arrangements set out in the fire safety strategy were complying with article 9 of the rro if implemented including the provisions

01:28:15 if implemented including the provisions for review the backbone of the strategy was to have a fire was to have fire risk assessments produced by a competent fire risk assessor

01:28:25 assessor a plan for raising actions identified and a tracker to monitor the closing out of such actions

01:28:32 actions looking at some other ways in which the tmo managed fire risks its systems including the fire risk assessments were points of discussion in health and safety committee meetings

01:28:43 in health and safety committee meetings they were a standing item in its annual health and safety reports and were a point of discussion at the meetings between

01:28:49 between lfb and the tmo they're also subject of scrutiny at the rbkc scrutiny committee the fire safety strategy was reviewed on a regular basis

01:29:00 a regular basis including following significant events such as the introduction of w-2 the adair and grenfell tower notices of deficiencies and concerns raised by rbkc

01:29:11 and concerns raised by rbkc and the tmo made appropriate changes when problems were identified dealing now with the question of carl stokes competence to carry out fras on behalf of tmo and the way in

01:29:22 fras on behalf of tmo and the way in which she did them in general terms the tmo considered him to be a competent fire risk assessor and fire consultant and there is strong evidence to confirm this was the case

01:29:35 evidence to confirm this was the case for example colin tel colin todd says of his fras

01:29:39 his fras the level of detail is in my experience well in excess of that normally included in fras the documented fras are amongst the most detailed of the many thousands of ever

01:29:50 detailed of the many thousands of ever fras i have studied in my opinion the level of detail goes well beyond that necessary for the fra to be regarded as suitable

01:29:57 suitable and sufficient so while the tmo accepts that there are some anomalies and possibly some redundancies in his fire risk assessment overall it's

01:30:08 fire risk assessment overall it's submitted the tma was and was entitled to conclude that he was competent

01:30:13 competent and producing suitable and sufficient risk assessment and there was never a point breach where it should have concluded that he was not competent

01:30:22 competent and dispensed with his services can i deal briefly with how he came first to be tmo's fire risk assessor for grenfell tower so as you know the fire safety order 2005

01:30:34 2005 heralded a change to approach towards fire safety wherein the previous regime was replaced with a system mandating a risk-based approach to fire safety by the responsible person

01:30:46 safety by the responsible person in late 2008 early 2009 the tmo rbkc and lf epa en entered into discussions about the suitability and sufficiency of the tmos

01:30:58 suitability and sufficiency of the tmos fra

01:30:58 fra program which resulted in a joint decision to procure specialist consultants to undertake fras across the tmo stock

01:31:09 the contract was put out to competitive tender and four tenderers submitted bids to the tmo the company's salvas consulting limiter was successful and was appointed to carry out the high risk

01:31:21 carry out the high risk premises assessment programme sabas was introduced the lfb who approved its approach

01:31:27 approach further lfb accompanied services assessors

01:31:31 assessors on fra visits to monitor their performance ensure that agreed standards were being consistently applied the tmo put the contract for medium low risk properties out to tender

01:31:42 out to tender and salvos and a number of other companies applied with all interviews conducted jointly with rbkc

01:31:48 with rbkc who had requested to be involved in the process

01:31:53 process the tmo interviewed around six organizations in august 2010 carl stokes and associates was appointed by the tmo and rbkc and so as you know carl stokes had

01:32:04 and so as you know carl stokes had previously worked force alberts and had done the initial risk assessment for grenfell tower in terms of experience carl stokes had been employed in the fire and rescue services for 23 years

01:32:16 fire and rescue services for 23 years before carrying out his first fire risk assessment for the tmo and had engaged in substantial academic and practical training beyond his operational firefighting role

01:32:28 operational firefighting role overall colin todd considers that carl stokes work experience academic and practical training and experience as a fire risk assessor was more than adequate to equip him for the role of fire risk assessor for

01:32:39 the role of fire risk assessor for grenfell tower in reaching this conclusion he notes that karl stokes had undertaken audits of the common parts of high-rise residential tower blocks and been part

01:32:51 residential tower blocks and been part of a working group that drafted very well known and established guidance on fire safety in certain types of housing so while of course the tmo accepts that as a responsible person

01:33:02 as a responsible person under the rro it ought to have kept karl stokes

01:33:06 stokes fras and ad hoc advice under review it submits the tmo says that it's unreasonable to think that it should have continuously second guessed his approach

01:33:16 approach in the way that dr lane has suggested first for a non-specialist organization such as the tmo to disregard specialist advice is a dangerous course for which it might

01:33:28 dangerous course for which it might rightly be criticized second while there may have been times when it was right to question his

01:33:34 his approach such as for example when lf epa expressed their concerns in january 2016 it submitted that tmo did follow up on

01:33:45 it submitted that tmo did follow up on these concerns and took steps to satisfy itself that he was producing suitable and sufficient risk assessments

01:33:54 the tmo is aware that the inquiry will examine its response to the queries raised by

01:33:59 raised by lfp lfepa in april 17 2017 in connection with the fire performance of the cladding and what dr lane describes as its shallow response

01:34:10 shallow response which he characterizes as a quick email absent

01:34:13 absent a quick email exchange forgive me absent of technical fact the tmo submits that dr lane's view places

01:34:22 places unrealistic expectations on it she appears to be saying that the tmo uniquely among the 2000 clients whose buildings were clad in unsuitable materials should have

01:34:35 in unsuitable materials should have itself been unable to unpick the systemic misconceptions and misrepresentations concerning the suitability of this type of cladding and insulation

01:34:48 of cladding and insulation so in fact karl stokes did investigate the fire performance of the cladding he states that he noted on the previous risk assessment again i quote cladding external non-combustible metal fixing signed off

01:34:59 non-combustible metal fixing signed off by bc

01:35:00 by bc i.e building control and he says that he understood that the system and component parts would have been compliant with the requirements of the building regulations and adb

01:35:14 regulations and adb that's when dr lane says in her phase 3 chapter 10 report that lf epa concerns regarding cladding should have been addressed within the fro process

01:35:22 process it's submitted this was done at least to an extent although so we note that there is a significant debate within professional circles or certainly was

01:35:31 was a significant debate within professional circles about whether the external wall of a building should indeed form part of a fire risk assessment at all so now turning to the system that

01:35:43 at all so now turning to the system that tmo had for dealing with actions identified by its fire risk assessments and notice notices of deficiency after an far fra action points

01:35:55 after an far fra action points identified were initially put onto the w-2 system by janice ray or cyril morris janice ray was unable to assign fra actions to departments and individuals within departments for completion

01:36:07 within departments for completion staff assigned actions would be expected to update the entry on the w-2 platform but only janice ray could mark the actions complete or partially complete

01:36:19 so we understand that if when actions were identified and targets set for closing them out those targets were sometimes

01:36:25 sometimes missed it will be a matter of concern to the inquiry but would submit this that it's partly a function of the number of historical actions that existed

01:36:34 existed and of the limitation on resource on resources

01:36:38 resources of course the tmo's aim was always to close out actions in time but the failure to have done so should not be taken to imply or connote a lack of urgency or disregard for the

01:36:50 a lack of urgency or disregard for the for safety by the tmo and its staff so we accept that the picture surrounding the closing out of actions

01:36:58 actions is statistically complex and it's accepted

01:37:02 accepted that the rate at which they were closed out varied quite substantially between 2013 and 2017.

01:37:10 2017. however to give an overall picture from december 2013 to june 2017 the total number of actions that have been assigned was according to dr lane 3300

01:37:22 according to dr lane 3300 and the total number completed was 2993 the tmos program for closing out action was scrutinized at senior levels for example the number of actions

01:37:34 example the number of actions outstanding was regularly reported to the health and safety committee and in 2016 this resulted in robert black

01:37:41 black pressing for actions older than six months to be completed urgently at the health and safety meeting on the 19th of january 2017 barbara matthews also raised a concern over the large

01:37:53 also raised a concern over the large number of actions which have been outstanding for over 12 months emphasizing the need to clear them urgently in fact she requested each team with outstanding actions prepare a written report

01:38:04 written report setting out the detail of each action assigned the steps taken and when the action would be fully completed and so the minutes of the health and safety committee meeting on the 16th of march

01:38:14 march show that this was done

01:38:18 focusing now on the most recent fire risk assessments for grenfell tower by carl

01:38:22 carl stokes and the extent to which actions identified there were closed out before the fire the action plan for the june 2016 fra indicated there were 47 items requiring

01:38:34 indicated there were 47 items requiring action

01:38:35 action and by 19th of october 2016 just before an inspection by the lfb only 22 actions were outstanding the tmo acknowledges may say so the tmo

01:38:48 the tmo acknowledges may say so the tmo acknowledges that dr lane says that some items were wrongly closed out and of course the inquiry will have to assess whether this was correct and if so what were its effects dr lane states that by the night of the

01:39:00 dr lane states that by the night of the fire of the seven items that remained open on the tracker five were marked as not fully completed and two completed while of course it will be a matter for the inquiry of the five items not closed

01:39:12 the inquiry of the five items not closed out it is submitted that none was relevant to the causes of the fire and only one was potentially relevant to the question of mitigation of the fire once it had started

01:39:23 once it had started so now deal with notices of deficiency following the lfb visit in october 2016 the lf epa issued a notice of deficiency for grenfell tower

01:39:35 for grenfell tower the nod listed actions which according to the notice should be taken by the 18th of may 2017 and related to seven issues which dr lane summarizes

01:39:47 dr lane summarizes in five issues all of the issues were identified as minor deficiencies by the lf epa

01:39:58 while it is correct that by the time of the time the fire the tmo had not resolved all of the issues all had been given substantial attention and so one of the issues raised by lf

01:40:10 and so one of the issues raised by lf epa was in relation to self-closers on flat entrance doors and the tmo fully accepts that inquiry will subject this particular issue to great scrutiny

01:40:23 great scrutiny in overall terms the tmo acknowledges that while there was undoubtedly a problem with door closers it did have visibility of the problem and a program was underway to retrofit

01:40:34 and a program was underway to retrofit retrofit them across the rbkc estate and so the following history is relevant to that consideration in march 2011 tmo entered into a

01:40:46 in march 2011 tmo entered into a contract with mance masterdaw for the renewal of flat entrance doors across its estate including granville tower between 2011 and 2013 mance master door

01:40:57 between 2011 and 2013 mance master door replaced 106 flat entrance doors to tennant and flats at grenfell tower it was a condition of the contract that the replacement doors would be

01:41:06 would be fd30s that is capable of resisting fire under test conditions for a minimum of 30 minutes and limiting the leakage of smoke to a prescribed

01:41:17 the leakage of smoke to a prescribed extent carl stokes himself was involved in the program to fit new doors and he later confirmed to the tmo that so far as he was concerned the new fire doors met the requirements

01:41:28 the new fire doors met the requirements of the building for regulations in terms of fire protection so the tmo notes the evidence suggesting that almost immediately after the doors were installed

01:41:39 were installed it was observed that some self-closing devices were insecure there is evidence in fact that the problem was brought to the attention of mance masterdoor who returned to remediate the problem

01:41:50 who returned to remediate the problem although it's noted that there's not appears to be any clear evidence to say what steps mance marcidor took and how many door closes were inoperative and again so we accept that the inquiry

01:42:01 and again so we accept that the inquiry will look at this particular issue closely so there's also evidence um also the evidence of sheamus dunleigh dunleau dunlay who was an esa and a state services assistant who is

01:42:12 and a state services assistant who is now sadly deceased the evidence being to the effect that he disconnected number of door closers at residence requests

01:42:21 requests so this is plainly concerning but it's noted the issue was raised in correspondence between janus ray and siobhan rumble both of whom you will hear from in in topic two of module three and it's

01:42:33 topic two of module three and it's understood that seamus dunlee was told to desist

01:42:39 so when in late 2015 the tmo received a notice in

01:42:43 notice in notices of notices in respect of a dare tower

01:42:47 tower which included recommendations in relation to fire doors it sought to introduce a barrel-wide replacement program it also responded to the matters concerning flat doors in the notice of

01:42:58 concerning flat doors in the notice of deficiency issued for grenfell in november 2016. the tmo did not have money in its existing budget to replace the fire doors

01:43:09 doors and it was necessary to revert therefore to rbkc for additional funding while it's absolutely right that rbkc agreed to funding it said that the period within which the door closes

01:43:20 period within which the door closes would be retrofitted would be five years not the three years the tma wanted the tmo also applied for funding to instigate a program of periodic inspection repair after

01:43:32 periodic inspection repair after replacement program but this was not agreed to by rbkc so tests conducted after the fire showed there were serious discrepancies between

01:43:43 there were serious discrepancies between the fire performance of the doors and the evidence submitted to the testing body in simplest terms they didn't have 30 minutes fire resistance represented by mance master

01:43:54 by mance master and so it's difficult to overstate the seriousness of this misrepresentation with this in mind the the tmo queries inquiries recent decision not to hear oral evidence from witnesses

01:44:06 not to hear oral evidence from witnesses from mance mastador the tmo would submit there's a strong argument for saying that these witnesses should be called to explain the situation

01:44:14 situation and their conduct just as witnesses from celetex

01:44:18 celetex archonic and kingspan were asked to explain their own products particularly sir as after the fire evidence has emerged of a more widespread of more widespread failures

01:44:30 widespread of more widespread failures in the performance of fire doors which led the then community secretary james brokenshire to conclude that there is evidence of a broader issue a call across the fire door

01:44:41 fire door market

01:44:45 so turning now to the provisions tmo made for dealing with vulnerable residents

01:44:52 the tmo accepts fully accept it was necessary to make provisions for the protection of vulnerable persons in a fire scenario through its fire risk management system

01:45:03 through its fire risk management system it notes the criticisms made in the opening statements by the bsrs and accepts that the inquiry will subject the arrangements it did make and the basis on which they were made to great scrutiny in this module

01:45:16 great scrutiny in this module the tma invites the inquiry to consider the provisions it did make for vulnerable residents against the background of the stay put policy and its adherence the lga guide

01:45:27 the lga guide these affected and largely determined its policy including its approach towards personal emergency evacuation plans or peeps

01:45:38 emergency evacuation plans or peeps in her report dr lane assesses and compares the wider guidance documents regarding vulnerable persons and fire risk

01:45:45 risk finding that the tmo and or carl stokes should as a minimum been required to consider the body of guidance as she puts it available and not focus on the lga

01:45:56 available and not focus on the lga guide she recognizes the lga guide provides substantially different advice to other guidance and by applying it duty holder would take a different approach towards safeguarding of vulnerable persons

01:46:10 safeguarding of vulnerable persons the inquiry will note that the guidance was produced by the lga or at least developed by the lj following the fire at lachnall house in july 2009 and published after wide consultation

01:46:21 and published after wide consultation including with dclg and the chief fire officers association the lga guy was substantially written indeed by the inquiry's own expert colin todd

01:46:33 todd and propose its adherence to the guy the chemo the tmo is a statutory body whose lawful obligation would be to follow guidance produced by dclg and lga

01:46:44 follow guidance produced by dclg and lga and so further the lga guidance post dates all of the other guidance that dr lane refers to having been produced in 2011.

01:46:55 in 2011. you heard these quotes i believe from mr maxwell scott just before my oral submission sir but can i um repeat them here the lga guide states that while there may be vulnerable persons in blocks of flats

01:47:06 persons in blocks of flats it is usually unrealistic to expect landlords and other responsible persons to plan for this or to have in place special arrangements such as peeps

01:47:17 such as peeps such plans rely on the presence of staff or others available to assist the person to escape in a fire paragraph 19 of the guide says the alternative the alternative to a stay

01:47:28 alternative the alternative to a stay put strategy is one that involves simultaneous evacuation and notes that this requires a means of alerting residents of the need to leave the building it observes that purpose-built flat

01:47:39 it observes that purpose-built flat blocks of flats such as grenfell tower are not

01:47:41 are not normally provided with general fire detection and alarm systems because experience has shown that most residents do not need to leave their flats when there is a fire elsewhere in the building indeed it says

01:47:53 elsewhere in the building indeed it says in some circumstances they may place themselves at greater risk if they were to do so the guide also suggested the risk inherent in the absence of a fire detection alarm system high-rise

01:48:05 a fire detection alarm system high-rise blocks is acceptable because it's very rare for there to be an extensive failure of compartmentation and this is consistent with the absence of improved document b

01:48:16 of improved document b of the requirements for high-rise residential buildings to be fitted with a means

01:48:20 a means of communicating with all occupants simultaneously in order to facilitate a total evacuation

01:48:30 indeed the state policy had been in place for many years at grenfell tower and was extensively communicated to the residents of the tower it was well known to lfb and lf epa and it was never suggested by either the tmo

01:48:42 it was never suggested by either the tmo should implement a full of aggregation policy either in place

01:48:46 place or in addition to a state put policy and the state put policy remains to date one approved for similar high-rise blocks by the national fire chiefs council

01:48:57 by the national fire chiefs council so in her report dr lane sets out three scenarios in which vulnerable residents may be affected where a fire occurs in a block with a stay put strategy these are where the fire occurs in the

01:49:08 these are where the fire occurs in the residence flat where it occurs in a neighboring flat where the fire has spread to the common parts

01:49:15 parts she says that the duty holder should make provision for three corresponding scenarios the occupants of the flat of fire origin make their escape occupants in any adjacent flats make

01:49:27 occupants in any adjacent flats make their escape and all other occupants in the building leave should a simultaneous evacuation strategy become necessary

01:49:36 so the timo accepts that you will no doubt assess whether in the light of the state

01:49:41 state policy and adherence to the lga guide the tmo should have prepared for all of these scenarios but it's respectfully submitted that we're making provisions for vulnerable residents the tmo is entitled

01:49:54 vulnerable residents the tmo is entitled if indeed not bound to work on the basis that compound tape compartmentation would not fail and all residents would stay put savor those stay safe for those in

01:50:05 put savor those stay safe for those in the flat of fire origin so now do now lastly with lifts and in particular the inability of lfb to take

01:50:16 particular the inability of lfb to take control of the lips so in your phase one report you said when the firefighters attended the fire at grenfell tower they're unable to operate the mechanism that should have allowed them to take control of the

01:50:27 allowed them to take control of the lifts

01:50:28 lifts why that was so is not yet known but it meant that they were unable to make use of the lifts and carrying out firefighting and search and rescue operations it also meant that occupants of the tower able to make use

01:50:40 occupants of the tower able to make use of the lifts and trying to escape in some cases with fatal consequences the ability of fire and rescue services take control of firefighting or fire lifts and high-rise building

01:50:51 lifts and high-rise building is often key to successful operations and so

01:50:55 and so may we echo your intention to examine this

01:50:58 this this serious issue with the greatest intensity

01:51:02 intensity so following the phase one report you the inquiry obtained evidence from various parties associated with the replacement of the lifts at grandfather tower in 2002 to 2005

01:51:15 at grandfather tower in 2002 to 2005 and the maintenance of them following the refurbishment including the maintenance of the fire control switch as the inquiry is aware between 2003 and

01:51:26 as the inquiry is aware between 2003 and 2006 the lifts of grenfell tower were replaced by apex lift and escalator engineers limited pursuant to a specification by butler and young consultants limited

01:51:38 by butler and young consultants limited butler and young did not specify that the replacement lift should not be firefighting lyft lift something the inquiries lift expert roger haukins criticizes in the event fully compliant fire

01:51:50 in the event fully compliant fire fighting lifts were not installed at a later stage carl stokes represented in his fras the lifts were fire fighting lips which was not correct in fact janice ray and robert catalan

01:52:03 in fact janice ray and robert catalan were both aware that they were not firefighting lifts despite carl stokes representations and so they in particular were not in fact misled janice ray always understood that the

01:52:15 janice ray always understood that the lifts would not be used to evacuate residents in the event of fire as the strategy strategy for grenfell tower was stay put turning to the maintenance of the lips roger haukin

01:52:26 of the lips roger haukin states that although there were some failures overall the lifts appear to have been maintained to an appropriate standard were generally in compliance with the relevant standards and industry

01:52:37 with the relevant standards and industry practice he did not think it likely that a maintenance failure caused the problems with the fire control

01:52:42 control switch following their installation the lifts at grenfell tower fell under a maintenance contract overseen by a contract manager within the building services team

01:52:53 the building services team the lift maintenance contract was apex lift limited the contract included monthly inspections so you're going to hear witnesses from peters i think paul and dunwoody

01:53:04 peters i think paul and dunwoody who will say that planned maintenance visits were carried out on a monthly basis

01:53:10 basis in accordance with the maintenance schedule

01:53:13 schedule the witness from peters will say that engineers would follow a standard checklist when conducting a service as well as ensuring the items list on the schedule were in good working order the engineers would ensure that the fire

01:53:25 the engineers would ensure that the fire control

01:53:25 control switch was in good and proper working order by inserting the correct key which at grenfell tower was an express drop key he says that they would insert the key into the switch

01:53:36 into the switch activate the system and check the lift would immediately move to the ground floor

01:53:41 floor before opening the doors they would then check the lift operated in the desired manner

01:53:46 manner i moved to the chosen floor before the doors would open when the correct buttons were pressed so we note the criticisms of dr lane and of course

01:53:57 of course we accept the tmo accepts that records of checks would have been desirable of course and that the checking of fire switch could have been a specific

01:54:08 fire switch could have been a specific item

01:54:09 item on the esa's checklist but so would say the absence of such records is not to be equated with the checks not having occurred

01:54:24 so in conclusion again to repeat what i said begin that the tmo acknowledges the immense tragedy of the grenfell tower fire and nothing that i've said is intended to diminish or detract from that tragedy

01:54:38 to diminish or detract from that tragedy so the tmo is not saying that it got everything right regarding the refurbishment or that its fire strategy and the way that it was applied was not capable of criticism and the tmo is

01:54:50 capable of criticism and the tmo is certainly not seeking to do this however we do urge the inquiry to exercise to judge the tmo figure me we do urge the inquiry to ensure that the tmo in itself are judged by an

01:55:02 tmo in itself are judged by an appropriate standard an appropriate standard and not one which was higher than was applied elsewhere at the relevant time so you know that these submissions have

01:55:13 so you know that these submissions have been drafted in order to set out the general position of the tmo in advance of the important evidence that will be heard in module three of phase two of this inquiry of course they've been prepared

01:55:24 they've been prepared with the statements in mind but without hearing that evidence and if anything said here is subject to review and anything said here is subject to review once that evidence has been heard and finally sir may the tmo and all the

01:55:36 and finally sir may the tmo and all the witnesses to give evidence in module three

01:55:38 three continue to offer their full support to the inquiry in fulfilling its important statutory functions

01:55:47 functions well thank you very much indeed mr gross that is extremely helpful we have three more oral opening statements to

01:55:58 three more oral opening statements to hear but they've all been programmed in for tomorrow's hearing and i think it would

01:56:04 would not be reasonably practical to invite any of those whom we're going to hear later

01:56:11 later to make their statements this afternoon so

01:56:14 so we are going to call a halt at that stage

01:56:18 stage we'll resume at 10 o'clock tomorrow morning

01:56:22 morning when as i say we'll hear some further opening statements good thank you all very much thank you

01:56:40 sir

01:56:50 you