Closing statements on firefighting modules. Mayor of London counsel outlines LFB reforms post-Grenfell. FBU's Martin Seaward argues disaster was caused by 'deregulation and the war on the culture of health and safety', defends firefighters and attacks outsourcing of training to Babcock as contributing to institutional failures.
00:00:29 the next statement we're going to hear is going to be made by miss stud queen's council on behalf of the mayor of london yes mr
00:00:44 thank you mr chairman the evidence called in relation to module 5 and module 6 part 1 has examined the operational response of the lfb on the night of the fire
00:00:55 the lfb on the night of the fire and has included an examination of where that response might have been lacking in coordination and effectiveness in particular it has examined what was
00:01:06 in particular it has examined what was known internally in relation to the risk of cladding fires in high-rise buildings and the extent to which those known risks
00:01:14 risks were communicated within the organization or by way of training it is essential that the tragedy of the grenville tower fire provides a focus for change both
00:01:27 fire provides a focus for change both within the lfb and indeed with other fire and rescue services
00:01:32 services and the central governmental approach to the reform of fire and building regulation nothing in these closing remarks should distract from the powerful
00:01:43 should distract from the powerful closings of the bsrs this morning the mayor supports the call for a hillsborough law and clearly recognises the need for a statutory duty of candor
00:01:54 statutory duty of candor in the public interest in his opening to module 5 the mayor set out the changes in governance of the lfb made pursuant to the greater london
00:02:05 made pursuant to the greater london authority act 1999 as amended by the policing and crime act 2017 the inquiry will be aware from the evidence called in relation to this
00:02:16 evidence called in relation to this module
00:02:17 module and the mayor's opening that prior to the 1st of april 2018 the lfb was overseen by the london fire and emergency planning authority referred to as el fipa
00:02:31 referred to as el fipa since the 1st of april 2018 the mayor appoints the deputy mayor for fire and resilience and the london fire commissioner sets the london fire commissioner budget and agrees its community risk management
00:02:44 and agrees its community risk management plan
00:02:45 plan which is the primary organizational strategy
00:02:51 the lfc has operational independence but the mayor retains the power to issue directions on the exercise of his or her functions
00:03:01 functions and directions were issued on the eighth first of april 2018 to set out the governance process for major decisions in short and to avoid lengthy repetition
00:03:14 in short and to avoid lengthy repetition the mayor and deputy mayor for fire and resilience have used the powers available to them under the new governance regime to ensure that the london fire commissioner provides
00:03:25 london fire commissioner provides greater assurance on how he is implementing necessary improvements and to undertake more intrusive monitoring this is done through various means
00:03:37 this is done through various means within both the gla and the lfb including regular process reports scrutiny at monthly board meetings and deep dive sessions
00:03:48 deep dive sessions the establishment of an lfc audit committee and the appointment of an operational assurance advisor a role created after your inquiries phase one report
00:03:59 report and the inspectorate inspection report to give an independent assurance on lfb's operational practice
00:04:09 from previous submissions provided by the mayor and others the inquiry will be aware of the steps taken by the current commissioner to reform and transform the lfb by
00:04:20 reform and transform the lfb by amendment and development of its policies procedures culture and training the lfc has published the transformation delivery plan which is supported by the
00:04:31 delivery plan which is supported by the mayor and addresses the findings of your inquiries phase one report and the inspectorate report as well as setting out priorities for wider reform
00:04:42 wider reform part of the evidence called in the course of module 5 and module 6 part 1 has demonstrated a number of areas where the lfb fell short of the standard of preparedness to be expected
00:04:55 preparedness to be expected such matters should not be laid at the door of individual firefighters on the fire ground but more upon the institution and the organizational structure
00:05:06 organizational structure the mayor particularly noted the evidence in relation to the following issues
00:05:11 issues one
00:05:11 one the quality rollout and monitoring of training for operational staff both on the fire ground and in the control room and the unsatisfactory process for improving training in response to known risks
00:05:24 training in response to known risks particularly but not exclusively in the light of the coroner's lacken or house fire recommendations secondly the lack of adoption of the
00:05:35 secondly the lack of adoption of the national operational guidance prior to the grenville tower fire thirdly the failure to adequately address the concerns raised regarding the utility of the communication system
00:05:47 the utility of the communication system being used at grenville and the evidence that they had been shown to be unsatisfactory on previous occasions
00:05:55 occasions fourthly the inadequate gathering of risk information during familiarization visits and indeed the inadequacy of the risk from familiarization visits generally
00:06:06 generally fifthly
00:06:07 fifthly the lack of preparedness by the lfb for the likelihood of a cladding fire in a high-rise building when experience had shown that such fires could and should
00:06:18 shown that such fires could and should have been realistically anticipated
00:06:22 sixthly the lack of review of known risks of high-rise buildings by central government post lachenal and up till now and in particular the failure to implement the review of building
00:06:33 implement the review of building regulations or take serious action to retrofit high-rise premises with sprinklers and seventhly the deeply concerning evidence of misogyny and racism within
00:06:44 evidence of misogyny and racism within the lfb which has no place in public service
00:06:48 service nor in our communities and must be rooted out
00:06:53 the inquiry and the bsrs will want to know what has been done to remedy the situation not only in the short term but in addition what steps have been put in place to ensure that the lfb cannot
00:07:07 in place to ensure that the lfb cannot and will not drift back into complacency as a result of the findings of the inquiries phase one report the lfc together with the deputy commissioner richard mills
00:07:18 richard mills a new director of people and a director of transformation and with the support of the mayor have made significant progress some of the issues detailed in this
00:07:29 some of the issues detailed in this closing closing although initially intended to address the recommendations in your phase 1 report also touch on the issues of concern raised in evidence in relation to module
00:07:41 raised in evidence in relation to module 5
00:07:42 5 and module six part one the key improvements delivered to date can be well illustrated first of all training
00:07:53 first of all training the inquiry is heard that post grenville the lfb commissioned an independent review of training which has been acted upon
00:08:01 upon the following changes have been made to date
00:08:05 date the lfb have made significant efforts to improve the effectiveness of lfb control the assistant commissioner for control a new role is implementing a controlling
00:08:16 new role is implementing a controlling improvement plan which includes a competency framework and enhanced training for staff a policy has been developed and adopted
00:08:27 a policy has been developed and adopted to enable and improve the simultaneous handling of a large number of fire survival guidance calls with relevant training of control room staff to enable them to manage the transition in advice between stay put
00:08:40 in advice between stay put to get out during an emergency incident when necessary
00:08:46 necessary the operational policy to enable control room officers to distinguish between callers seeking advice and callers requiring rescue has been revised and implemented by way
00:08:58 has been revised and implemented by way of training in respective control room staff there is now regular and specific refresher training
00:09:07 training the lack of a trained evacuation procedure prior to the grenville tower fire which was also absent in national guidance has been identified in the course of the inquiry as a blind spot
00:09:18 course of the inquiry as a blind spot and has now been remedied by the lfb but national guidance remains outstanding training in the risks of external external wall fires in high-rise
00:09:30 external wall fires in high-rise buildings is now provided to all operational staff together with training in the evacuation of such buildings backed up by appropriate policies the effectiveness of the new approach
00:09:42 the effectiveness of the new approach was demonstrated at the new providence war fire
00:09:45 war fire in may of 2021 the lfb have also introduced the use of smokehoods to facilitate rescue from smoked-filled environments
00:09:56 smoked-filled environments and the issue of compliance with national operation guidance on incident command was raised by the inspectorate in their first inspection of the lfb the lfb is now prioritizing the
00:10:07 the lfb is now prioritizing the implementation of the national operational guidance and has an incident command strategy to ensure that all commanders are trained
00:10:16 trained and or reva revalidated as soon as possible
00:10:21 possible so far as familiarization visits are concerned the lfb policy on gathering and managing operational risk information including the procedures for the completion of premises risk assessments has been updated
00:10:34 assessments has been updated and firefighters have been trained in relation to the implementation of the new policy what is most important is how this is working in practice and this has been reviewed by the lfb
00:10:45 and this has been reviewed by the lfb operational assurance advisor and the lfb have initiated a long term project called one risk with the aim of significantly enhancing how risk information is recorded and
00:10:58 information is recorded and used the issue of communications has several strands the policy covering communication between the incident commander and the control room operators has been reviewed
00:11:09 control room operators has been reviewed and a dedicated communication link is now provided between the instant commander
00:11:15 commander and the senior control room officer to enable better management of the fire ground
00:11:21 ground a system of direct communication sharing critical information between the control room and the instant commander has been developed and the communication between the instant command on the bridgehead
00:11:32 the instant command on the bridgehead has been improved the servers on the command units have been upgraded to enhance connectivity and usability of the command support system software
00:11:43 system software and lfb is in the process of procuring new radios and breathing apparatus and the gla has asked for assurance work to be undertaken to ensure that those new systems
00:11:54 systems fully address the failings identified in grenville
00:12:01 the lfb have adopted a diversion and inclusion strategy this has already resulted in a more diverse workforce than was present in 2017
00:12:10 2017 but there is considerable further work to be done in collaboration with the mayor the lfb has announced an independent review of its culture led by nazir asphalt obe
00:12:22 led by nazir asphalt obe to deal with these issues swiftly and efficiently and to provide recommendations to the lfb on such matters
00:12:31 however these changes and improvements are only as good as the systems in place to ensure sustained change and a culture of continual improvement complacency cannot be permitted to
00:12:43 complacency cannot be permitted to return
00:12:46 the inquiry will want to know why and how the new government system will make a difference when lfb was previously monitored by elfipa and did not deliver the quality of service that londoners
00:12:58 the quality of service that londoners were entitled to expect the mayor and the lfb have been strengthening the insur the assurance processes following the grenfell fire tower fire particularly after your phase
00:13:10 tower fire particularly after your phase one report to ensure that risks are being managed recommendations are being implemented and improvement measures achieve the intended outcomes
00:13:21 intended outcomes the mayor acknowledges the impact of the inquiries phase one report in revealing some of the failures that the lfb has been addressing since publication
00:13:32 been addressing since publication within the lfb a new business assurance framework has been introduced the commissioner has appointed an audit committee and an independent operational assurance advisor tasked with providing
00:13:44 assurance advisor tasked with providing assurance on the lfb operational policy and practice including assessing whether the implementation of the key recommendations from phase one have been effective
00:13:55 effective on behalf of the gla the deputy mayor for fire and resilience has established a fire and resilience board to scrutinize performance to challenge the lfb on its improvement
00:14:06 challenge the lfb on its improvement work as well as providing for questioning major decisions which have already been through the lfb governance process
00:14:12 process before they're approved by the deputy mayor
00:14:15 mayor the commissioner and all senior staff from the lfb attend the board the board meets monthly with an additional deep dive session to help to scrutinize specific issues in
00:14:28 to help to scrutinize specific issues in more depth as and when required including on implementation of your recommendations the gla fire team supports and enhances the deputy mayor and the gla oversight
00:14:40 the deputy mayor and the gla oversight of the
00:14:41 of the lfb
00:14:43 lfb in relation to the recommendations of the phase one report there's been a sustained focus on delivery with the mayor publishing a monthly report updating londoners on the progress of your recommendations made in
00:14:55 progress of your recommendations made in phase
00:14:56 phase one however hovering over all these steps being taken in order to improve performance and monitoring of the lfb is the issue of resources
00:15:07 of resources as the mayor has highlighted in earlier modules there are significant fire risks in london's built environment which have been further placed in the spotlight
00:15:17 spotlight by the tragic fire at grenville tower the past and continuing failure by central government to grapple with and reform building regulation both in relation to its substance and
00:15:30 both in relation to its substance and its compliance has resulted in buildings being built and modified using unsafe materials and substandard installation many buildings are deemed to be so
00:15:42 many buildings are deemed to be so lacking in safety standing standards that they're now subject to specific and expensive safety measures such as waking watch
00:15:52 there is no evidence to date that there's been any coherent analysis undertaken by government as to how much it will cost to protect the public from unsafe buildings and how much is
00:16:03 unsafe buildings and how much is required to fund the fire and rescue services to enable them to protect the public appropriately from these known risks in the future as an indication of the scale of the
00:16:14 as an indication of the scale of the challenge
00:16:15 challenge the government has required lfb to audit over eight and a half thousand high-rise buildings
00:16:20 buildings in london as part of the building risk review program of all high-rise buildings in the pro in the program across the uk 58
00:16:31 58 are in london further it is clear that the scope of this programme does not capture all at-risk buildings in our city
00:16:42 at-risk buildings in our city the greater appreciation of risk post-grenville has not been reflected in increased resources as the mayor has previously highlighted following central government's recognition of issues in the built
00:16:54 recognition of issues in the built environment raised by this fire the lfb received 5.5 million pounds to carry out fire protection activities this funding has been reduced for 2021
00:17:06 this funding has been reduced for 2021 to 22 to 3.9 million with no guarantee that it will continue in future years the mayor has called on central government to make this a permanent
00:17:17 government to make this a permanent increase to reflect the current knowledge of risk the significant reductions in funding for the lfb between 2009 and 2016
00:17:28 for the lfb between 2009 and 2016 cannot be discounted as a contributing factor to the reduction in training or equipment across the organization under the fifth london safety plan
00:17:39 under the fifth london safety plan published in 2013 10 fire stations were closed and 27 appliances removed whether this in fact made a difference on the night of the grenville tower
00:17:50 on the night of the grenville tower might be difficult to determine but it demonstrates a depletion of resource for the london fire brigade with an absence of reinvestment elsewhere in the system
00:18:02 elsewhere in the system since 2016 the mayor has consistently funded the lfb at higher levels than those sent by central government in the funding that they provide to him for this purpose
00:18:14 for this purpose in 2021 22 the mayor provided 16.8 million to the lfb above the government expectation it is beyond doubt that the wider financial challenges
00:18:26 financial challenges imposed in part by the impact impact of the kobit 19 pandemic make this increasingly difficult to sustain
00:18:36 this inquiry has allowed for a detailed examination of the cultural effectiveness of the lfb and it has been found lacking as a result of the phase one report considerable change has already taken
00:18:48 considerable change has already taken place within the lfb supported by the mayor
00:18:52 mayor the mayor has already demonstrated his sustained focus on ensuring that the recommendations from your report remain a central feature of the transformation of the brigade
00:19:04 of the brigade he is similarly committed to ensuring that the lfb learns from the findings and recommendations which disseminate from phase two the bsrs deserve to know
00:19:17 the bsrs deserve to know that the london fire brigade and those responsible for ensuring and monitoring its effectiveness have addressed and will continue to address the issues which have been found wanting
00:19:28 wanting so that the fire brigade can deliver the service that londoners deserve
00:19:34 thank you thank you very much the next statement is going to be made by mr martin seaword on behalf of the fire brigades union say mr seaword if
00:19:46 fire brigades union say mr seaword if you're ready do come up please and make your statement
00:20:06 oh
00:20:13 [Music]
00:20:23 good afternoon's here enough members of the panel and assessors
00:20:28 just get my toy working
00:20:38 a word in response to this morning submissions if i may on behalf made on behalf of the bsrs the fbu fully supports the calls for
00:20:50 the fbu fully supports the calls for public sector duty of candor with teeth and a national oversight body to ensure that recommendations by proper authorities are monitored and followed up
00:20:59 up the fbi appreciates the support of bsr team 2
00:21:03 team 2 and recognizes the criticisms of bsr team 1 which deserve full consideration the fbu wishes to assure the bsrs and this inquiry that the fbu will consider them carefully
00:21:18 these submissions are supported by evidence cited in our written submissions uh which to save time we don't repeat here
00:21:26 here we are willing to provide any references which the inquiry may request starting with a summary although the lessons can and must be learned from a disaster including by the lfb and the
00:21:37 disaster including by the lfb and the wider fire and rescue service the building failure was so total and the systemic failing is so widespread across the country that it would be wrong to scapegoat the fire and rescue service for the failures of central
00:21:48 service for the failures of central government and a corporate culture that made people's homes unsafe the disaster was not caused by the nfb but by individual private companies which were allowed to put profit before people
00:21:59 allowed to put profit before people grenfell was the culmination of a generation of central government policies including deregulation and the war on the culture of health and safety privatization fragmentation austerity and the degradation of social housing
00:22:11 and the degradation of social housing weaknesses in the preparation and performance of the lfb can be traced back to the decision of central government to remove any form of national body for discussing and developing national standards strategy
00:22:22 developing national standards strategy equipment and operational guidance across the fire and rescue service the nfp's work was impeded by austerity cuts and privatisation for decades before grenfell
00:22:35 the government cannot fragment and cut away at public services and yet expect them to shoulder ever greater responsibilities any deficiencies in the performance of the lfb were institutional or due to
00:22:46 the lfb were institutional or due to inadequate senior management they were not the failings of the individual firefighters or control staff who attended the disaster they did their best in accordance with their training and experience to save lives in face of
00:22:58 and experience to save lives in face of an unprecedented catastrophe the fbu strongly supports improved training for firefighters and more extensive inspections and these require proper resources it's easy now just to say staples should
00:23:10 it's easy now just to say staples should have been revoked and the tower evacuated by the first two instant commanders however this was without previous precedent in june 2017 even now after four and a half years
00:23:21 after four and a half years there's no national guidance on the full revocation of stay put and evacuation of a high-rise in the event of a major fire we contend it's unfair to criticize the first two instant commanders
00:23:32 first two instant commanders for not revoking statehood in the first hour of the disaster the individual firefighters who attended the disaster including the first two instant commanders and the supervisors of the control room staff
00:23:43 supervisors of the control room staff should be relieved we submit of any individual blame grenfell tower was not their fault moving on to the context in which the fire and rescue service is being criticized
00:23:54 criticized grenfell was a perfect storm after the manufacturing companies manipulated the flawed testing and certification regime the private companies involved in the refurbishment of grenfell tower created a wholly unsafe building surrounded by
00:24:06 a wholly unsafe building surrounded by highly flammable material from which the tmo's under-resourced and ineffective fire risk management system failed to safeguard the residents and then when it became an inferno the emergency response was unable to rescue
00:24:18 emergency response was unable to rescue 72 of them the lack of care shown by the private companies involved in the disastrous refurbishment of grenfell tower and by the tmo as the primary responsible person was facilitated and enabled by
00:24:30 person was facilitated and enabled by policies made since 1979 by central government in the service of a social and economic system driven by the pursuit of profit above all else including people this agenda has been the dominant
00:24:41 this agenda has been the dominant political ideology of most politicians in central government for decades we submit the relationship between government policy making and the interests and demands of business in this sector has been politically corrupt
00:24:54 this sector has been politically corrupt deregulation and the war on the culture of health and safety facilitated the use of inflammable cladding that destroyed grenfell tower it explains the government's refusal to provide further guidance on approved document b and led to the fire safety
00:25:06 document b and led to the fire safety regulations not being taken seriously within an all-embracing culture of complacency deregulation of fire safety legislation for the
00:25:14 for the by the regulatory reform fire safety order of 2005 deterred principal officers for example from pushing the need to clarify fire safety legislation as they feared it would lead to even more deregulation
00:25:25 would lead to even more deregulation based on the government's one-in-two out policy
00:25:28 policy deregulation of the fire and rescue service led to the abolition of national standards of emergency response resulting in amongst other things a diminished predetermined attendance and the failure to research and develop a
00:25:39 the failure to research and develop a guidance for better communications and for the revocation of stay put and evacuation of a high-rise involving fire privatization weaken public services and introduce conflicts of interest between
00:25:50 introduce conflicts of interest between safety and profit as we've seen in the testing and certification regimes in the lfb privatization led to lengthy delays in the provision of needed training including incident command training following la canal and
00:26:02 training following la canal and prevented recruitment in the control room despite staff being below the minimum required this in turn reduced the provision of fsg training fragmentation and other policy
00:26:13 fragmentation and other policy of the fire and rescue service led to the abolition of the central fire brigades advisory council and the fire service inspectorate absence of such national bodies was a factor in the repeated failure to learn
00:26:24 factor in the repeated failure to learn lessons from international fires or to address and resolve known problems affecting all brigades degrading social housing chronic under investment over decades has enabled the cheapest is best culture
00:26:36 has enabled the cheapest is best culture to develop with any standard of materials planning supervision and workmanship becoming acceptable and austerity cuts took a significant toll on the lfb which
00:26:47 took a significant toll on the lfb which was already under resourced when they were introduced in 2010 in the decade preceding grenfell the numbers of whole time firefighters were reduced by 22 control staff by 13 and total staff by
00:26:59 control staff by 13 and total staff by 23
00:27:01 23 the cuts of the 9th of january 2014 saw the forced closure of 10 fire stations including both westminster and knightsbridge and the loss of 14 fire appliances plus the loss of over 500
00:27:12 appliances plus the loss of over 500 firefighter jobs then mayor of london boris johnson removed a further 13 appliances in 2016. cuts had also led to the removal of an aerial from the high-rise predetermined attendance pda
00:27:24 attendance pda into 2005 a reduction in the number of fire safety officers less training and the failure to recruit more control room staff
00:27:31 staff andy rowe said there's a level of investment in armed policing public order in the military that is absent in the fire and rescue service because fire is thought of as solved cuts and austerity do not excuse the
00:27:43 cuts and austerity do not excuse the significant failings of principal management to prepare their operational staff to deal with a disaster such as grenfell but they hampered the ability of the lfb both in their preparations in the run-up
00:27:54 both in their preparations in the run-up to grenfell and in their ability to respond on the night they provide some explanation as to why these failures occurred we agree with the remarks of professor torreira to the warren center fire
00:28:05 torreira to the warren center fire engineering project launching australia on the 24th of july 2018 while these hearings were still underway in phase one he said so the expectation that the fire
00:28:16 he said so the expectation that the fire service should have understood building performance the expectation that the fire service should have been able to manage the fire is a really unfair expectation document controller please screen the transcript
00:28:28 transcript on day 191 page 171 at line 24 and following
00:28:35 asked about um thank you asked about um
00:28:39 um that statement by council's inquiry on the 21st of october 2021 professor terrero clarified so the point i wanted to make
00:28:48 to make was that it was an unfair thing to blame those who are on the ground for all the mistakes they're making when those who actually should have the competency to enable them to do a proper job have not managed to deliver that level of
00:28:59 managed to deliver that level of competency that makes them capable of performing the task i followed said council so should we read the word far service when you say the expectation that the fire service
00:29:10 the expectation that the fire service should have been able to manage the fire is a really unfair explanation as limited to those members of the fire service on the instant ground and professor torreira replied yes of course
00:29:20 course as we submitted right at the outset of phase one sir the fire fighters and control staff have also been deeply affected by the grenfell tower disaster and it's unfair in our submission to blame them
00:29:31 blame them the fbu we set out the role of the fbu in our opening oral submissions for module 5 and don't don't repeat that here but wish to respond that some some of the criticism of the fbu made in
00:29:43 of the criticism of the fbu made in these modules gti is not yet called or heard from representatives of rank and file firefighters in respect to these criticisms which we submit cannot fairly be accepted without this further
00:29:54 be accepted without this further evidence
00:29:55 evidence the fbu firmly rejects the suggestion by our former uh commissioner mr dobson and commissioner andy rowe that industrial election by its members was in any way responsible for any of the failures of
00:30:06 responsible for any of the failures of the lfb including in relation to learning the lessons from lack of house or in the provision of training they were clutching at straws trying to deflect blame for the significance and long-term failures of the principal officers leading the
00:30:17 the principal officers leading the brigade
00:30:19 brigade there is no evidence the fbu's lawful industrial election was a factor in the failures of the lfb's principal officers to properly train their operational crews
00:30:27 crews including disseminating lessons from major fires such as lacking where there have been difficult industrial relations in london at times they've been the consequence we say of principal officers such as mr
00:30:38 we say of principal officers such as mr dobson seeking to worsen the terms and conditions of the lfb workforce and to reduce their number for example firefighters were shocked and angered by his threat in 2010 to fire and rehire
00:30:50 his threat in 2010 to fire and rehire the entire workforce on reduced terms and conditions the fbu negotiated the settlement after two days of industrial action
00:30:58 action again in response to the lfb seeking to implement the government's proposal to reform firefighters pensions by raising the normal retirement age from 55 to 60 so that they would know they would work
00:31:09 so that they would know they would work longer pay more contributions and get less benefits the fbi ran a hands off our pensions campaign the government's proposals were later held to discriminate unlawfully against firefighters
00:31:20 firefighters as part of this legitimate campaign fba members took strike action nationally on 50 occasions between 2013 and 2015
00:31:31 on 50 occasions between 2013 and 2015 totaling 11 days of strike action over 37 different days for a varying bearing from one hour to four four days long each time so that's a total of 11 days strike
00:31:43 so that's a total of 11 days strike action over 14 months from 2013 to 2015. mr dobson said these strikes were a factor in not rolling out training including training based on a presentation on fires in high-rise
00:31:54 presentation on fires in high-rise buildings entitled tall building facades they can't have been the tool for building facades presentation was first developed in july 2006 long before the strikes in 2013-15
00:32:05 long before the strikes in 2013-15 a further presentation for the lfb fire safety staff was prepared in 2015 i after the industrial election was over there is no link between this industrial election and the lfb's failure to inform
00:32:18 election and the lfb's failure to inform and train operational crews on the dangers of cladding systems on high-rise residential buildings further the failures of training on pn633 lacking house and the fire safety staff presentation were also post june
00:32:31 staff presentation were also post june 2015.
00:32:33 2015. again as the industrial election had ended that cannot have been a factor in the failure of lfbs principal officers properly to train their staff on these matters
00:32:43 matters the fbu makes no apology for seeking to defend its members and the fire and rescue service that is what it exists to do the fbi rejects the notion that it represents a conservative force that's
00:32:54 represents a conservative force that's unwilling to change it has frequently led the debate on issues such as improved fire safety the need for great professionalism equality and diversity and the need to plan and train for new and emerging risks such as
00:33:06 train for new and emerging risks such as those arising from climate change the fbu recognizes sorry the fbi rejects any suggestion that the disaster was contributed to by some form of heroic macho need to get into the fire and to
00:33:19 macho need to get into the fire and to prioritize firefighting over everything else
00:33:21 else there is no reliable evidence to support this being an issue amongst firefighters in the lfb it's not as if they have ignored policies or procedures or failed to apply their training or fail to take more technical training
00:33:33 or fail to take more technical training seriously
00:33:34 seriously they responded to grenfell in accordance with their training and experience but were not provided with the policies or the training to cope with the unprecedented situation they confronted
00:33:46 unprecedented situation they confronted the fbu has continually pressed for improved training and professional standards including for more effective 72d visits to enable firefighters to better serve the public and to protect the lives of firefighters
00:33:58 the lives of firefighters it has warned as far back as 1999 in evidence given to the investigation of westminster about the dangers posed by cladding fires following the fire at ghana court it is warned that lessons were not being learned from lacrimal house and other
00:34:09 learned from lacrimal house and other major fires in 2013 the fbu provided a written statement and matrak gave oral evidence on the 9th of september 2013 to the house of commons clg committee investigation into the review carried
00:34:21 investigation into the review carried out by ken knight explaining the impact of cuts on national resilience and the need for a cfbac type body he said and i quote our view is that there is evidence that fire services are
00:34:32 there is evidence that fire services are not learning lessons from earlier tragedies and then we have coroners identifying that precisely the same point that has been made in a previous coroner's inquest is now being made in a subsequent one i think alarm bells
00:34:44 subsequent one i think alarm bells should be raised in the fire and rescue service about that matter we need a proper thoroughgoing debate around that and an inspectorate is a very valid part of that process that we would want to see
00:34:55 it has also welcomed the re-establishment of the lfb equalities unit
00:35:00 unit and
00:35:01 and as you know sir it's committed to this full and open inquiry its members gave their evidence openly and without the assistance of lawyers and on their behalf
00:35:09 behalf the fbi has invested in the importance of learning the lessons from each and every fire to try and help save lives
00:35:18 if i can move on to the failure to translate knowledge of cladding risks into policy the government and the principal officers in the lfb were aware since 2010 that combustible cladding and bridges of compartmentation had created a risk of
00:35:30 compartmentation had created a risk of rapid fire spread in and over high-rise residential buildings that some of them were being refurbished without complying with the building regulations and were not being maintained according to the fire safety order
00:35:41 fire safety order this awareness was neither conveyed to operational crews nor addressed in policies guidance or training the inquiry has already noted the lack of national guidance in respect of revoking statement and evacuation
00:35:52 statement and evacuation and mr mcgurk accepts that there was no procedural guidance nationally or internationally on how an emergency evacuation of a high-rise could or should be achieved that no training or policy for evacuating a high-rise
00:36:04 policy for evacuating a high-rise residential building had been adopted by any fire and rescue service before grenfell
00:36:09 grenfell at local level the rice approach was not investigated by any fire and rescue service outside the chief fire officers association southeast region mr mcgurk told the inquiry that rice was
00:36:21 mr mcgurk told the inquiry that rice was only just on his radar in 2015 and that despite several fatal high-rise fires the risks to occupants were not appreciated and alternatives to high high-rise firefighting were not on the
00:36:32 high-rise firefighting were not on the agenda
00:36:33 agenda we submit this was primarily the fault of central government which in the drive towards localization abolished the cfbac and the fire inspectorate leaving no
00:36:44 and the fire inspectorate leaving no central body managing knowledge and sharing hazard and risk information in the uk fire and rescue service thereafter government failed to invest in fire research and whether from the cfoa nfcc the chief fire and rescue
00:36:58 cfoa nfcc the chief fire and rescue advisor cfra or the fire minister himself failed or herself failed to provide high-rise guidance options such as rice should have formed the basis for discussion research and
00:37:10 the basis for discussion research and policy development at a national level it is unrealistic even where the subject matter is drawn to their attention to expect fragmented under-resourced fire and rescue services across the country to be on top of what
00:37:22 across the country to be on top of what what might be happening at another fire and rescue service without adequate resources or national coordination the inquiry has heard evidence that the lfb did not have the resources to learn
00:37:33 lfb did not have the resources to learn from other risk critical industries and that there had been an erosion of professional standards in london and nationally since 2003 with the dismantling of national structures
00:37:44 dismantling of national structures the dearth of national guidance under section 21 of the fire and rescue services act or otherwise was not just an on evacuation there was no national guidance on other big issues of importance to all fire and
00:37:56 big issues of importance to all fire and rescue services that needed to be researched and developed including on poor communications the increasing prevalence of rain screen cladding systems on existing often old high-rise residential buildings on the
00:38:07 high-rise residential buildings on the high risk of compartmentation breaches on the requirements for responsible persons to prepare evacuation plans especially peeps and on the various recommendations made
00:38:18 and on the various recommendations made by coroners and other proper authority following earlier tragedies including the recommendations to retrofit sprinklers we submit it's unfortunate mr mcgurk who serves as expert to this inquiry having
00:38:29 serves as expert to this inquiry having been a leading figure in the cfla for 15 years before grenfell was not questioned further on why he and other senior fire and rescue leaders failed
00:38:38 failed to provide any form of operational guidance on training or training on when and how to revoke staple and evacuate a high-rise which might have made a significant difference in grenfell to deal with the issue of more effective
00:38:49 deal with the issue of more effective radio communications instance through the cfoa's technical committee or to share learning from international fires and fires in different brigades even though this was part of its role
00:39:01 even though this was part of its role mr mcgurk accepted that a national body or at least a national campaign to launch paris would have been helpful we submit that a properly resourced national body crucially including the involvement of firefighter
00:39:12 involvement of firefighter representatives is not just helpful but essential
00:39:16 essential to ensure that knowledge of risk is translated into policies and guidance which are properly discussed and then disseminated and implemented across the fire and rescue service delegating this process to over 40 separate local fire
00:39:28 process to over 40 separate local fire and rescue services to invent the wheel independently of each other was frankly as the fbu said loudly in 2004 a recipe for disaster
00:39:40 moving on sir to familiarization visits seven two days the chair has already found that they were inadequate and that given their lack of training no personal criticism can be made of watch
00:39:52 personal criticism can be made of watch manager dowden or any other firefighters who visited grenfell before the fire to carry out 72ds the evidence in these modules fully supports that conclusion crews were neither expected by management nor
00:40:03 neither expected by management nor trained to do more than they did as to purpose assistant commissioner brown the principal officer responsible for 70 lead visits said their purpose was familiarization and that crews were not
00:40:14 familiarization and that crews were not expected to assess the likelihood and impact of fast spread beyond the compartment mr mcgurk agreed the purpose was to collect simple accurate information to aid the officer in charge to make rapid decisions on arrival at an incident
00:40:27 decisions on arrival at an incident dr grimwood told the inquiry that before grenfell he would not expect crews to be picking up on differences of construction materials panels etc as part of the 72d process we submit further that with no aerial on
00:40:39 we submit further that with no aerial on the pda
00:40:40 the pda crews could not be expected to familiarize themselves with sighting an aerial at any high-rise building supplying it with water or seeing how high the water could be thrown up the facade
00:40:50 facade the evidence in these models shows also that the lfb did not have the training or the resources to properly carry out 72d visits as to training mr brown said the training provided for these visits did
00:41:01 training provided for these visits did not cover the testing of radio communications nor the identification or treatment of external panels facades or modern methods of construction or the possible external fire spread over the walls were building frontline crews did not have the
00:41:12 frontline crews did not have the technical knowledge to look in depth of breach of compartmentation and fire safety regulations and watch managers were not separately trained to carry to carry out risk assessments on seven two
00:41:23 carry out risk assessments on seven two days nor how to train their crews to do so
00:41:27 so as to resources no discrete time was allocated for doing seven two days thinking about them or writing them up all of this was done while crews were on the run and liable to be called away
00:41:39 to be called away uh
00:41:40 uh dc george and ac cowp and ac brown all had reservations about whether it would be possible to visit all high-rise the lfb didn't even have a basic database listing them all
00:41:51 listing them all ac brown told the inquirer that initially they aimed to visit all high-rise buildings annually but once the enormity of the task became apparent they had to take a more risk-based approach
00:42:01 approach mr daily mr dobson said there were not enough fire safety officers to look at 20 000
00:42:06 20 000 building consultations a year in order to carry out joint inspections with crews
00:42:11 crews this echoes the evidence from phase one for example mr ricketts was asked would you chase up a further 72d visit to test all these outstanding matters
00:42:22 to test all these outstanding matters and he answered to be honest sir no because of the volume of 70d visits we do it's hard to schedule in further 72d visits
00:42:31 visits moving on to paris sir neither the porous guidance nor nor its introduction to the fire and rescue services was properly thought through and the fbu contends was a further victim of central
00:42:42 was a further victim of central government agenda deregulation and cuts the implementation of porris was not just defective in london mr mcgurk told the inquiry that if anything it landed better in london than many other fire
00:42:53 better in london than many other fire rescue services porus was almost bound to fail
00:42:57 to fail due primarily to central government and the way it was introduced as to the guidance itself mr mcgoat pointed out that paris potentially conflicted with the established purpose of seven to seven two d visits and effectively
00:43:09 seven two d visits and effectively trying to combine two functions a thorough risk analysis on the one hand and simple accurate information to help the innocent commander on the other which could have caused confusion additionally the fbu had concerns that
00:43:21 additionally the fbu had concerns that the proposed risk matrix in paris valued a firefighters life too low and this issue required resolution at a national level but instead it was left in negotiations at local level
00:43:33 negotiations at local level wasteful
00:43:34 wasteful as to its introduction it was wholly unrealistic to expect the existing and established practice of familiarization visits
00:43:41 visits to change simply by issuing the non-mandatory porous guidance in 2012 in austerity without even a series of seminars or conferences to explain it was a radical shift and moreover to
00:43:52 was a radical shift and moreover to introduce it without providing or warning
00:43:55 warning of the significant training implications the need for additional resources including the significant involvement of fire safety officers and additional time to carry out the visits as mr george told the panel sadly due to
00:44:07 as mr george told the panel sadly due to resources and budgetary constraints there weren't enough fire safety officers
00:44:12 officers mr mcgurk said also that after 2005 links were already weakened between the fire safety departments and operational crews who rarely undertook fire safety investigate inspections as they were
00:44:23 investigate inspections as they were focusing on community fire safety work the fbu supported and supports enhanced inspections to help protect both the public and firefighters guidance such as porris
00:44:35 guidance such as porris should be developed at a national level in conjunction with stakeholders across the fire and rescue service including the trade unions and
00:44:43 and should be in the form of mandatory national policy and not left the discretion of individual fire and rescue services which can only lead to further fragmentation and different approaches being adopted across the country
00:44:55 being adopted across the country and of course it must be properly resourced and preceded by proper training here there was none the lfb's equipment and adequacy for the purposes of high-rise firefighting
00:45:07 purposes of high-rise firefighting here the fbu focuses on communications and aerials communications were a further victim of deregulation fragmentation in the cards there was no national guidance for local fire and rescue services which is
00:45:18 fire and rescue services which is professor johnson reported separately faced the known problems in the field of communications including propagation issues affecting the use of uh f radios in high rise concrete buildings which
00:45:30 in high rise concrete buildings which had been highlighted and made the subject of recommendations in previous inquests and investigations professor johnson reported that the systems available at grenfell did not meet an acceptable level of reliability
00:45:41 meet an acceptable level of reliability were again ineffective and again put residents and firefighters at increased risks
00:45:47 risks these problems emerged as unintended consequences of the choice of equipment and systems relied on for fire ground communications with limited coverage and signal localization congestion and interference
00:45:59 congestion and interference here we see another massive training gap mr groves told the inquiry that the hoped for training solution to the communications problems identified at lacanal were not delivered by babcock to
00:46:10 lacanal were not delivered by babcock to cruise before groundfall the babcock training package contained only a very basic description of lfb's communications equipment and did not instruct crews about the difficulties encountered when
00:46:21 difficulties encountered when firefighting in high-rise buildings there was no specific radio communications training for firefighters beyond their initial training none of the reading materials available to firefighters train them how to
00:46:33 to firefighters train them how to optimize communications to overcome a total coms failure why those difficulties occur or how to overcome them in high-rise buildings a word about repeaters and leaky feeders
00:46:45 a word about repeaters and leaky feeders only
00:46:46 only edba extended duration breathing operators were as we're given practical training on how to deploy radio repeaters and leaky feeders the support package for senior officers
00:46:57 the support package for senior officers did not instruct that high-rise materials such as concrete and metal can disrupt signals nor distinguish between radio repeaters and telemetry repeaters untrained and unpracticed and through no fault of their own
00:47:08 fault of their own firefighters at grenfell mistakenly deployed telemetry repeaters instead of radio repeaters airwave radios these could well have assisted crews that attended grenfell mr mcgurk agrees
00:47:20 that attended grenfell mr mcgurk agrees with professor johnson that they have advantages being digital with better coverage and reliability and with the capacity for talk groups as mr o'keefe told the chairman in phase
00:47:31 as mr o'keefe told the chairman in phase one an airwave radio would have been useful at the bridgehead on the night the failure to provide airway radios or other reliable means of communication for crews working inside the tower
00:47:42 for crews working inside the tower was another casualty of austerity and the regime of cuts although denied by gary reason resistance to the wider use of airwave radios was driven by cost as identified in internal lfb emails
00:47:54 identified in internal lfb emails referred to in professor johnson's report
00:47:58 report the fbi admits that proper communications on the fire ground are essential
00:48:02 essential and the development of communication systems should not be left to cash strap fire authorities even one as big as london
00:48:08 london again this should be the responsibility of a national body a word about aerials provision of an aerial appliance was dropped from the predetermined attendance for high-rise incidents from
00:48:19 attendance for high-rise incidents from 2005 due to cuts the fbu does not suggest having an aerial would have been a cure-all or guarantee stopping a cladding fire or the safety of residents but we submit that mr should address the question
00:48:31 that mr should address the question whether an aerial on the pda would have made a difference to the outcome at grenfell
00:48:36 grenfell not being on the pda paddington's turntable turntable ladder a213 did not arrive until 132 it took a further 10 to 15 minutes after its arrival for it to become operational
00:48:49 its arrival for it to become operational by about by about 145 it then applied water to the east face of the tower until sometime before 2 25. dr lane's report shows a photograph of it applying water to the east facade at
00:49:02 it applying water to the east facade at 205
00:49:04 205 reaching about floor 10 before it had to be moved due to falling debris soho's
00:49:11 soho's aerial arrived a245 arrived later and was set up in seven minutes it then applied water to the east face of the tower for most of the early hours the downward external fast grid was
00:49:22 the downward external fast grid was halted between floors ten and between floors seven and ten on the north west and south sides by the use of handheld jets and ground monitors
00:49:31 monitors it was halted much higher at floor 18 on the east side due to the use of an aerial
00:49:36 aerial which thus markedly reduced external downward fast spread dr grimwood told the inquiry that an exterior stream from an aerial appliance could be used to control the spread of an external fire
00:49:47 an external fire if an aerial had been on the pda from 2005 we submit it's reasonable for the panel to draw the following inferences as to pre-planning aerials would have been considered on 72ds for high-rise residential buildings
00:50:01 72ds for high-rise residential buildings crews would have been trained on and familiar with the use of an aerial at grenfell siting it on the east side and supplying it with water at that location they're likely also to have worked around the problem of sighting it on the west side
00:50:12 west side of the tower by arranging for the removal of the bollards and to have engaged with specialist bulk media advisors to overcome the water supply problems they may also have considered the problems of applying water to the north
00:50:23 problems of applying water to the north and south sides either by sighting an aerial there or otherwise
00:50:28 otherwise and would have had in any event a greater awareness of the limitations of an aerial at grenfell
00:50:36 and on the night an aerial appliance mobilized by the pga could have been on the scene at 1 13 and within minutes it could have been applying water to the east side of the tower where the fire was spreading upwards and breaking in not reaching the
00:50:48 upwards and breaking in not reaching the top until 126. mr mcgirt declined to speculate on whether a better outcome could have been achieved with better resources this is an important stone left unturned
00:50:59 this is an important stone left unturned in this inquiry we submit mr mcgurk should be asked to give an opinion on this issue particularly in light of dr stoyanov's evidence but if not then it's open to the panel to conclude that an aerial on the pda
00:51:11 to conclude that an aerial on the pda would have made a difference both to pre-fire preparation and to the emergency response on the night moving on to training and outsourcing to babcock we've dealt with communications
00:51:23 babcock we've dealt with communications and won't repeat that
00:51:26 and i refer without citing um paragraph 27.26
00:51:32 27.26 of your phase one reporter in which you um
00:51:36 um exonerate um watch manager dalton and those who accompanied him on 72d visits saying that um that
00:51:47 that they can't be blamed for for the inadequacy of those visits and you went on to say it's equally plain however that they they had been given no training in the evacuation of high-rise buildings generally or in how to recognize the need to evacuate such a
00:51:59 recognize the need to evacuate such a building or how to carry out such an operation safely these failings were institutional in nature and no personal criticism can be made of watch manager dalvin or any other firefighter who visited the tower before the fire
00:52:14 the principal officers evidence in these modules has substantiated those findings so former commissioners dobson and cotton and assistant commissioners brown and daley accepted significant failings
00:52:26 and daley accepted significant failings including the operational crews were not trained in the revised pn633 after 2015 nor in the lessons from lachenal
00:52:34 lachenal nor when and how the staple strategy should be reversed and the practical real fire training proceeded on the basis that fire would rarely extend beyond the compartment of origin
00:52:44 origin after the fire in the maddingly block in kingston in 2010 mr firkins of the lfb's fire engineering group reported we may want to advise as an injury measure that early evacuation
00:52:55 an injury measure that early evacuation of the building should be considered rather than defend in place an increase in the pda may be justified to support this end of quote but this information was not passed to
00:53:06 but this information was not passed to the crews nor did fire engineers in the fire safety department assist in developing pn 633 for high rise nor did the principal officers address the issue that mr firkins had had
00:53:18 the issue that mr firkins had had raised
00:53:20 raised maddingly was just one of many such examples of missed opportunities to learn as an organization due in part complacency from senior leaders who did not appreciate that a fire of this scale could occur and
00:53:31 fire of this scale could occur and seriously underestimated the risk associated with high-rise residential buildings
00:53:36 buildings the culture of complacency was evident in mr dobson's presentation to insurers less than a year before grenfell entitled
00:53:43 entitled high rise
00:53:44 high rise not high risk given these admitted failures to train and inform operational crews it's very difficult to see how a junior officer can be fairly criticized for not revoking state put and evacuating the
00:53:56 revoking state put and evacuating the tower
00:53:59 tower outsourcing a key reason for the lfb's training failures was the outsourcing of training to a private contractor babcock in april 12.
00:54:07 12. it was pushed through very quickly ahead of elections in may 2012 anticipating a change in the political control from conservatives to labor the lfb was thus tied to a contract for 25 years for which babcock lacked the
00:54:20 25 years for which babcock lacked the expertise and was not ready to fulfill the fbu strongly opposed the decision to privatize trading and the lfb's experience with babcock from 2012 to 2017 shows they were right
00:54:31 2017 shows they were right this was most starkly evident in the lack of training for instant commanders moving on then to instant commander training
00:54:39 training babcock's lack of subject matter expertise led to significant delays and ultimately its failure to revise a revised incident commander course or any interim training package on the lessons
00:54:50 interim training package on the lessons of lacknow house prior to the disaster the inquiry has learned that principal officers misinformed elected members that
00:54:58 that and i quote babcock has confirmed that all seven issues those are latino issues all seven issues are covered in the existing suite of command training this was inaccurate
00:55:09 this was inaccurate the existing training needed enhancement although aware of babcock's lack of expertise and its failure to address the lack of issues mr reason spared babcock the scrutiny of elected members babcock
00:55:20 the scrutiny of elected members babcock likewise tried to cover up its lack of expertise
00:55:23 expertise alasdair coming of babcock sent an email to mr groves about instant command training saying i'm satisfied the requirements of the coroner have been met and can be reported as such this was not the case
00:55:35 this was not the case steve green of the learning and development strategy team wrote in an email on the 14th of december 13 the alastair coming of babcock knew fully well the requirements of the corridor had not been met and was trying to pull
00:55:47 had not been met and was trying to pull a fast one but mr green's concerns were not followed up by principal officers having initially recommended the development of 16 command decision exercise scenarios cdes to start with
00:56:01 exercise scenarios cdes to start with this was quickly reduced to proposal six and then was further reduced to one the holcroft house cde this was completed by august 2016 three years after the coroner's
00:56:13 years after the coroner's recommendations in march 2013 to which it was a wholly inadequate response it was restricted to to level one instant commanders it only envisaged two fsg calls half the number of lack of
00:56:25 two fsg calls half the number of lack of and it gave no guidance on why the incident commander should consider a full or partial evacuation if the building had had remedial work and failed to train firefighters on the extent of the risk posed by external
00:56:36 extent of the risk posed by external fast spread and poor complementation it gave no guidance on how to go about conducting a partial full evacuation of the block
00:56:46 there were also structural problems with outsourcing with the dismantlement of the lfb's own internal training department which could no longer provide internal training and the loss of the five-day training course
00:56:58 the loss of the five-day training course for station-based trainers from april 2012.
00:57:03 there was a a serious conflict of interest here we submit
00:57:08 submit the the inquiry should approach the evidence of mr dobson on outsourcing and future training provision for the lfb with significant caution
00:57:16 caution he did not make it clear that since his retirement as commissioner he's worked as a consultant for babcock a very clear conflict of interest he was not questioned about this obvious conflict of interest despite it being
00:57:27 conflict of interest despite it being raised with the inquiry we submit parts of mr dobson's evidence to the panel was unreliable particularly the effect that one the responsibility for providing subject
00:57:38 the responsibility for providing subject matter experts for babcock was with the lfb
00:57:41 lfb this as chair noted in in evidence this is a surprising statement given given that babcock had sought and won the contract to provide training and in so doing must have professed that they had the necessary expertise
00:57:53 the necessary expertise and two he disagreed with the former commissioner cotton that prior to the outsourcing of training to babcock any required training could be provided he volunteered this at the end of his evidence and did not explain his country
00:58:05 evidence and did not explain his country view
00:58:09 so our conclusion on babcock this is a further example of central government policy privatization impacting on the lfb in a way that may well have contributed to the disaster the lfb senior leaders were at fault bringing in
00:58:21 senior leaders were at fault bringing in babcock and then having done so failing to ensure they were providing the necessary training without the introduction of bad there would have been sufficient expertise in the training department and significant delay would have been avoided
00:58:32 delay would have been avoided training issues identified by the lack of coroner could have been dealt with far earlier certainly by june 2017 the panel will need to consider whether the judgment of lfb's principal officers
00:58:44 the judgment of lfb's principal officers was affected by their being too close to a profit-making private company evacuations stay put the chair has found that stay put should have been reversed at some point between 130 and 150
00:58:56 130 and 150 and evacuation order had been attempted mr mcgurk has agreed while stressing the serious risks and difficulties of such an attempt and noting that prior to the grimlock tower fire there was no practical guidance to fire rescue
00:59:07 practical guidance to fire rescue services on how it could be done neither national nor international as i said earlier operational crews in london had not been informed that building failure wasn't
00:59:18 informed that building failure wasn't rare compartmentation could not be relied upon and that some cladding materials were combustible nor of the heightened risk of total building these combined risks presented in cladding
00:59:29 combined risks presented in cladding high-rise residential buildings involved in fire nor of the resulting need to consider revoking staple and evacuating such a building and hadn't been trained when or how to do so however mr mcgurk has neither
00:59:41 however mr mcgurk has neither volunteered nor been asked despite the fbu's suggested lines of questioning submitted the inquiry as to how a full evacuation could have been achieved that night consequently we are left with his opinion
00:59:53 opinion that it should have been attempted notwithstanding that the state but strategy had never before been fully revoked nor had a high-rise residential building involved in fire ever been fully evacuated
01:00:04 fully evacuated these were institutional failures of central government cfoa and the lfb which render unfair the criticism of the initial instant commanders for failing to revoke statehood a move to evacuate the building
01:00:16 the building a word about generic risk assessment 3.2 neither that nor any other policy gave any guidance on how to evacuate a high rise involved in fire nor on the
01:00:27 a high rise involved in fire nor on the circumstances that would trigger an evacuation peter callup told the inquiry that for the entire uk fire and rescue service consideration of evacuation was something of a blind spot there was no
01:00:38 something of a blind spot there was no national guidance to cover it nor did gra 3.2 warn of cladding and other construction features which promote abnormal or rapid fire spread charged with the task of revising gra
01:00:50 charged with the task of revising gra 3.2 mr cower misunderstood the risk from cladding as being only the creation of voids that would conceal fire spread not that the crowding itself would burn given that the bre and the government
01:01:01 given that the bre and the government were aware of the risks of fan book cladding as early as 1991 and mr cowb was drafting guidance on behalf of a government department we echo his question why did they not bring this to his
01:01:12 why did they not bring this to his attention
01:01:14 attention professor bisbee reports that the the risk of rapid fast spread associated with combustible cladding systems was deliberately downplayed by government and this significantly contributed to the widespread misunderstanding of this
01:01:25 the widespread misunderstanding of this risk
01:01:26 risk he reported the noseley heights overcladding scheme represented not one flagship policy but many and has unearthed a handwritten note evidencing a request from a government press office
01:01:37 a request from a government press office to play down the issue of the fire in 1991
01:01:43 1991 it required a national body with government support to grasp the evacuation metal for high-rise residential buildings and either to resolve it by issuing national guidance such as now recommended by the chairman or to close
01:01:55 or to close high-rise residential buildings with combustible cladding the government and the cfoa failed to grasp this nettle what about rice and the kent standard operating procedure
01:02:07 operating procedure rice and the kenshop did not deal with or provide guidance to firefighters in relation to a full evacuation of a high-rise residential building in the event of a major fire spreading beyond the compartment of origin at most it raised the possibility of
01:02:19 at most it raised the possibility of evacuation as one of the possible strategies to consider right from the start of a high-rise incident in june 2017 rice was not then a policy in kent but a command decision-making tool an aid memoir to alleviate command
01:02:31 tool an aid memoir to alleviate command stress and prompt a predetermined rapid analytical thought process where local or total building evacuation may be given earlier consideration prior to a firefighting intervention
01:02:42 firefighting intervention even now there remains no policy or method even in kent for evacuation of a high-rise residential building involved in fire and at the time of grimfield rice had not been adopted by all the other fire and rescue services in the
01:02:53 other fire and rescue services in the southeast region rice was and is not some sort of magic formula there is no certainty the rice approach would have made a difference mr mcgirk said it might have but no more than that he recognized that any attempt
01:03:05 than that he recognized that any attempt to apply rice would have been would have been would have faced the particularly challenging circumstances of grenfell and
01:03:13 and mr brown on behalf of foe has already outlined
01:03:17 outlined i won't repeat those the fbu has concerns about kent's policies the stairwell protection strategy could expose firefighters to significant and avoidable danger by
01:03:28 significant and avoidable danger by placing them above the bridge head without breathing apparatus or with ba sets that have not been started up dr grimmond was not asked about this issue and instead described tbf-15
01:03:40 tbf-15 without any challenge by council's inquiry as to the impact this procedure might have on firefighter safety these proper concerns remain policies requiring firefighters to go
01:03:51 policies requiring firefighters to go above the bridgehead without activated breathing apparatus were proposed in the lfb and in greater manchester but both have have since been withdrawn in the lfb this this followed the
01:04:02 in the lfb this this followed the finding of an independent health and safety advisory panel in manchester the policy was was withdrawn following an application for judicial review by the fbu a third fire and rescue service
01:04:13 a third fire and rescue service hampshire and the isle of wight is persisting with such a policy and the fbu have again applied for judicial review in that case there have been too many firefighter fatalities in high-rise residential buildings to ignore firefighters health
01:04:26 buildings to ignore firefighters health and safety in designing policy mr mcgurk noted the kent sop was wanting on mobility challenged evacuation and emphasized in the strongest terms the need to avoid jumping to a simplistic
01:04:38 need to avoid jumping to a simplistic conclusion that had the kent sop been in place it would have prevented fatalities of grenfell the fbi accepts that rice wasn't is worthy of consideration research and
01:04:49 worthy of consideration research and development at a national level in consultation with the fire and rescue services
01:04:54 services with responsible persons with the fbu and others although the union would not support lowering existing breathing apparatus safety standards the fbu notes that dclg and cfoa did not
01:05:06 the fbu notes that dclg and cfoa did not investigate rice before grenfell we welcome the development work that is now happening as a result of the chairman's recommendations 33.22 amb
01:05:16 33.22 amb we contend it should have received such consideration much earlier but didn't due to the fragmentation of the fire rescue service and the evolution of hmi fs and cfpac
01:05:28 and here we are four and a half years afterwards and still no national guidance on evacuation despite that recommendation
01:05:37 policy note 633 the lfbs principal officers now accept there was no guidance
01:05:42 guidance in
01:05:43 in pn120 or anywhere else as to when and how state books should be withdrawn or the alternative strategies should be implemented mr reason sought to qualify this however by saying that evacuating a high-rise
01:05:54 by saying that evacuating a high-rise was not unusual particularly partial evacuation the fbu strongly disputes this and contends that in living memory in the uk no high-rise residential building
01:06:05 no high-rise residential building involved in fire had ever been fully evacuated before 14th of june 2017. there had been partial evacuation of the flats approximate to or directly above the fire flat as it
01:06:17 or directly above the fire flat as it shepard's court an action that was in fact undertaken at grenfell alongside self-evacuation and rescues
01:06:23 rescues instant commander byles at the adeer tower fire said he did not revoke stay put
01:06:29 put and asked about this mr dobson did not understand what he had actually done we say this is not an example of revoking statehood fully or partially the fbu contends that stay put was not
01:06:41 the fbu contends that stay put was not revoked either of these or at any fires before grenfell
01:06:51 the rbkc and tmo between them had not provided any evacuation plan for grenfell residents beyond staple strategy so there was no responsible person's plan for the incident commanders to build upon that night
01:07:03 commanders to build upon that night mr daley had never come across an instance where the responsible person for a high-rise residential building had in place a contingency evacuation strategy which included changing
01:07:14 strategy which included changing to a full evacuation of the building in the event that the state book policy had to be abandoned
01:07:22 and on that recommendation that you've made sir
01:07:27 sir not much is is yet happening beyond the temporary waking watches in high rise residential buildings with with dangerous crowding a culture change is still needed amongst
01:07:38 a culture change is still needed amongst responsible persons to initiate the process of planning and practicing evacuation drills the government is in favor of implementing recommendations 33.22 c e and f
01:07:50 33.22 c e and f for responsible persons of acu evacuation plans and peeps but must now back its implementation by responsible persons and residents and its enforcement under the fire
01:08:02 and its enforcement under the fire safety order with national guidance and resources
01:08:06 resources this all begs the question how can mr dowd and mr walton be realistically criticized for not doing this in the first hour of the emergency response
01:08:17 moving on to the decision making models and research watch manager dowden and station manager walton were trained in and applied the normative decision-making model
01:08:29 normative decision-making model dr cohen hatton's research showed that 80 of instant commander's decisions are reactive to what they're seeing either instinctively or by learned behavior and that
01:08:37 that the dmm
01:08:39 the dmm was not sufficient to help instant commanders avoid falling into decision traps
01:08:44 traps she found that a watch manager is more likely to be using intuitive processes than a more senior commander with more time
01:08:52 time the decision control process dcp was developed to introduce a stop and think stage between making a provisional decision and implementing it likewise in 2010
01:09:03 likewise in 2010 much earlier dr grimwood had found in his first two seminars using a facade fire scenario involving rapid external fast spread that the kent instinct commanders were all thinking only of fighting the fire
01:09:15 all thinking only of fighting the fire and not exploring other options by contrast after being trained to consider other tactical options using the rice mnemonic dr greenwood and his colleagues in kent saw outstanding improvements
01:09:27 improvements these were theoretical exercises and there's no evidence of how the training was applied in practice notwithstanding the recommendation of the national operational guidance nog or instant
01:09:38 operational guidance nog or instant command on instant command and the future of instinct command both documents published in 2015. watch manager dowden and station manager walton were not trained by the lfb and
01:09:49 walton were not trained by the lfb and did not apply either the new decision control process for instant commanders or the right mnemonic based on their lack of such training on the night of the of grenfell
01:10:00 the night of the of grenfell dowden and walton were likely to react and we contend should not be criticized for reacting in accordance with the way they were trained namely by persisting and trying to effect rescues and fight the fire
01:10:11 effect rescues and fight the fire instead of considering other options such as revoking stakeholders and fully evacuating the tower we submit the incident commanders were doing their job to the best of their ability in accordance with existing
01:10:22 ability in accordance with existing policy their training and experience they did so in unprecedented and appalling circumstances the grenfell tower fire was unprecedented because never before in the uk had a fire in a high-rise residential building spread
01:10:33 high-rise residential building spread out of control to engulf even one complete facade let alone the whole building
01:10:38 building they wanted and tried to save lives the failings identified in phase one were entirely due to a combination of institutional failings in the fire and rescue service both nationally and within the london fire brigade which
01:10:50 within the london fire brigade which undermined the lfb's emergency response and deprived these individuals of the tools they needed to revoke statehood and evacuate the tower they were not individually responsible for any of these institutional failings
01:11:04 for any of these institutional failings additionally and taking a broader view the fbu further contends it's unfair and disproportionate to continue to hold the firefighters and instant commanders responsible for any part of the tragic loss of life and suffering occasion by
01:11:16 loss of life and suffering occasion by the fire in face of the evidence disclosed in phase two which we've referred to already
01:11:25 document controller i wonder if you'd be kind enough to put that up again um the same
01:11:30 same passage from torreira and once again we cite professor torreira's important clarification which you can see on screen expressing his view that would be really unfair to expect those on the instant
01:11:42 unfair to expect those on the instant ground to manage the fire
01:11:46 so moving on so to our request to the panel and to you and the panel to to relieve instant commanders of criticisms in the phase 1 report
01:11:56 report accordingly the fbu respectfully asks you to revisit those criticisms
01:12:07 this is essentially for not having uh taking the decision to revoke stakeholders and evacuate the tower between 130 and 150. in addition to their innocence of the systemic failings outlined above the fbu
01:12:20 systemic failings outlined above the fbu asks the panel to take into account the following firstly if as the chairman has found the early incident commanders could not conceive the possibility of mass compartmentation failure and the
01:12:32 compartmentation failure and the consequent need to consider and then order a total evacuation of the building this was due to their relevant uh their lack of relevant training and experience the possibility was foreseeable by the lfb as has now been
01:12:43 foreseeable by the lfb as has now been conceded by commissioner rowe and yet the incident commanders and the crews under their command were not informed of it nor trained what to do if they should encounter it without being alerted to the risks of this possibility the instant commanders
01:12:56 this possibility the instant commanders could not reasonably be expected to consider improvise and then order a total evacuation of the building they should not be criticized for their failure to do so in face of grandfather
01:13:07 in face of grandfather secondly it wasn't reasonably obvious that responses to fsg calls were ineffective until significantly later than 150.
01:13:15 than 150. which manager dowden did not know of any fsg calls until after 135 when the first admin called c8 command unit 8
01:13:24 unit 8 started the first list of three fsg calls was taken by watch manager kenfield to downton when he was talking to to station manager loft just before 1 40.
01:13:35 40. the first operational response to an individual fsg call was not attempted until 151 when firefighters cornelius and murphy were briefed at the bridgehead to rescue a man now known to
01:13:46 bridgehead to rescue a man now known to be dennis murphy from flat 111 on floor 14.
01:13:51 14. they tried repeatedly to contact the bridge head on their handheld radios to say that they would not be able to bring the people down but they received no answer and heard no radio traffic they did not debrief the bridgehead
01:14:03 they did not debrief the bridgehead until around 2 19 their end of where time
01:14:10 thirdly wash manager dowden could not have been expected to obtain information about the success
01:14:16 success of search and rescue deployments in response to fsg calls before he handed over command at about 150. in line with pn 790 and as discussed with station manager loft he reasonably
01:14:27 with station manager loft he reasonably tasked loft with coordinating the emergency response to fsg calls soon after 1 40. at his hand over to walton shortly after 150 dowden didn't have any information
01:14:38 150 dowden didn't have any information about the operations inside the tower and there was too much traffic on the radio to communicate with the bridgehead this is likely to be true both because mr dowden was a patently honest witness and because there were difficulties
01:14:50 and because there were difficulties communicating from outside the tower to the bridgehead and vice versa although others were aware of the poor conditions higher up the tower dowden was not having tried but failed to radio
01:15:01 was not having tried but failed to radio the bridge head crew manager stern and firefighter hipple later informed o'keefe at the bridgehead about 138 of the poor conditions they had witnessed on floor 16 and of the failed rescue attempt on
01:15:15 16 and of the failed rescue attempt on floor 16 with one person still unaccounted for but watch manager o'keefe had lost radio comes with dowden after make make pumps 10 at 124 and was not communicating with
01:15:26 10 at 124 and was not communicating with him and sorry and what was communicating with him via watson and other officers as runners dowden does not recall receiving this critical information which he probably
01:15:37 critical information which he probably never received due to communications problems
01:15:41 problems watch manager dowden cannot reasonably be expected to have known the stairs would only remain passable for a limited period by 1.50 nor station manager walton by two o'clock this could only have been worked
01:15:53 o'clock this could only have been worked out by receiving reports of poor conditions in the stairway which he did not receive or by observing the reduction in numbers of self-evacuees from 1 50 to 2 o'clock
01:16:05 of self-evacuees from 1 50 to 2 o'clock he didn't log the rate of self-evacuation for which he was not trained and had no experience and so he did not have this information
01:16:16 moving on uh sir to to the control room fsg policies training and understaffing
01:16:25 uh user found that the control room was overwhelmed by unprecedented number of 999 calls which together with the magnitude and speed of the spread of fire presented each member of the control room team on duty that night
01:16:36 control room team on duty that night with a challenge wholly outside their experience and training you found there were serious shortcomings in the operation of the control room which could not be attributed not all be attributed to the scale of the incident and which were in the main systemic
01:16:49 and which were in the main systemic systemic failings in the control room fsg policies uh you found the there were deficiencies in the fsg policies pn539 and pn 790
01:17:02 pn539 and pn 790 and the reference information files created there under and we've set these out in our written opening statement for module 6am and only briefly summarize them here they couldn't cope with more these are
01:17:14 they couldn't cope with more these are the policies couldn't cope with more than about six fsg calls at a time gave no guidance on what control staff should do when the number of fsg calls occupied all the available control room operators and so the
01:17:26 control room operators and so the capacity of both the fsg policies and the control staff were already outstripped by 130 and notwithstanding paragraph 293 of the lfb lacanal report they did not warn of
01:17:38 lfb lacanal report they did not warn of the danger of assuming without information from the instant ground that firefighters are on the way and rescuers at hand
01:17:44 at hand or of the consequent risk of lulling callers into a false set of security
01:17:51 failure to deliver training in control is another of the systemic institutional failures that led to the disaster control staff had limited experience of taking fsg
01:18:03 had limited experience of taking fsg calls and so training was particularly important to them yet as mr george accepted there was a chronic and systemic failure to plan deliver and record training in control joanne smith encountered difficulties
01:18:15 joanne smith encountered difficulties with pulling control staff from the watch for training the issue surrounding vision crowded out consideration of other issues that were affecting control the training audit recommended by station manager kelly in 2010 never
01:18:27 station manager kelly in 2010 never materialized partly due to vision training sidelining everything else notwithstanding joanne smith's scathing review in september 11. in 2012
01:18:39 in 2012 only 68 of staff undertook fsg training and in the following years less than 30 percent undertook any kind of fsg training
01:18:48 training accordingly the expected post lacking or fsg training including annual refresher training did not materialize the role play element of fsg training with fire safety officers promised after lacking was never implemented
01:19:01 lacking was never implemented an assistant operations manager norman who fulfilled the role of operations manager on the night had not been trained how to supervise the control room
01:19:10 room the recommended two-week supervisory package with the minerva type exercise was never created or delivered nor was she ever trained on when in what circumstances and how to change the staple of advice or what to do if
01:19:22 the staple of advice or what to do if the number of fsg calls occupied all the control room operators or otherwise how to cope with a major incident generating multiple fsg calls
01:19:32 calls the limited training of some cros facilitated for some command units did not train any of them to engage in two-way communications between the instant ground and control
01:19:43 instant ground and control this is confirmed by the command unit workshops injects which required no information from the instant ground and so it was not two-way communications as joanne smith told the inquiry in
01:19:54 as joanne smith told the inquiry in phase one on the 11th of july 2018 as usual
01:19:58 usual we are the ones that pass information to the crews
01:20:01 the crews and to the instant commander and to the interesting command pump it's not really a two-way channel
01:20:09 understaffed particularly with supervisors it's now clear the control room was understaffed having lost 21 posts over the period from 2011 to the night of the fire these posts were lost due to a failed
01:20:20 these posts were lost due to a failed attempt at privatization in the control room the cams project which led to the temporary loss of five control staff from 2011 made permanent from 2012. the introduction of vision software
01:20:31 the introduction of vision software which led to the loss of three control staff to the operational support team from 2014
01:20:37 from 2014 to the night of the fire which required a lot of staff time to develop fixes and train staff how to use them and the assumption of new functions the resource management center that led to the loss of seven staff
01:20:48 that led to the loss of seven staff and the fire and rescue national coordination center that leads to the loss of six staff without recruiting any additional staff on the night control had minimum numbers on duty
01:21:00 control had minimum numbers on duty eight control operators and three supervisors and when joe smith arrived at about 2 15 she was and i quote what she said in her statement her first statement to the
01:21:12 statement her first statement to the police she said she was acutely aware that we needed more staff and in particular supervisors to help there were tears lots and lots of tears looking around i can only describe the staff as broken
01:21:26 aom assistant operations manager norman fulfilled the role of operations manager and whereas there should also have been three
01:21:34 three uh
01:21:35 uh aoms on duty with her there are only two debbie reel and peter may this put them all under increased pressure especially in the early stages of the fire when they started to receive fsg calls
01:21:47 fsg calls and so we submit that with deficient policies limited experience and absence of relevant training and a shortage of staff including supervising officers the control staff were not provided with the tools to enable them to handle the
01:21:58 tools to enable them to handle the multiple fsg calls generated by grenfell to liaise with the instant commander to discuss the worsening situation or to reverse the statement advice of the specific criticisms
01:22:09 of the specific criticisms uh made in your phase one report sir um
01:22:13 um aom norman and to a lesser extent her fellow supervisors are criticized in particular for failing to seek information from the instant ground about the progress of operations the development of the fire and the
01:22:24 the development of the fire and the actions being taken to resolve fsg calls despite setting up a direct phone link with with cu 8 and speaking to watch manager america 135 and 147
01:22:35 manager america 135 and 147 that's uh
01:22:36 that's uh paragraph 29 1 170 a
01:22:41 1 170 a for failing to stand back from taking 999 calls from 130 to 140 when the flow of
01:22:48 of fsg calls became a flood and deciding how to manage the collation and transmission of fsg information to the instant grounds in a way that ensured that clear lines of communication were established between the control room and
01:22:59 established between the control room and the command unit and for failing to realize that in some cases control room operators were not obtaining all the necessary information or should have reminded them of the need to do so even on the briefest of calls
01:23:12 on the briefest of calls in relation to these specific criticisms we ask the chairman and the panel to take into consideration the following additional factors the information from the fire ground was dynamic with callers
01:23:24 the fire ground was dynamic with callers changing locations making it difficult to identify their whereabouts in the early stages aaron norman rightly we submit prioritized communicating the first fsg
01:23:35 prioritized communicating the first fsg calls to cu-8 on the fire ground and did not complete that task until around 1 50 when the control room was still inundated with 999 calls two control room officers have been
01:23:47 two control room officers have been unable to radio the first service requests the instant command pump g271 despite multiple attempts from 131-135 unbeknown to control there was no one
01:23:59 unbeknown to control there was no one manning the main scheme radio on the instant command pump with all the firefighters on the fire ground being busy on other duties and the messages were not received in between taking 999 calls
01:24:11 in between taking 999 calls aom norman rightly we submit prioritize communicating these fsg calls to the first command unit on the far ground
01:24:18 ground in the admin line call that started at 135 with watch manager merrick she gave him such details as she had including flat numbers and flaws she explained the control room was inundated
01:24:30 explained the control room was inundated and they were overwhelmingly busy she then took another 999 call at 1 39 she received watch manager merrick's message sent at 143 that cu-8 was set up and ready for further messages whereupon
01:24:42 and ready for further messages whereupon she made her second admin call to watch manager merrick starting at 1.47 again giving him all the information she had about each fsg call we submit it was not reasonably
01:24:53 we submit it was not reasonably practical during either of these calls for aom norman to ask watch manager merrick for any information from the instant ground about the progress of operations the development of the fire and the actions being taken to resolve
01:25:04 actions being taken to resolve fsg calls he'd only just arrived cu-8 was still setting up and he could not be expected to have any useful information moreover they were both consumed with information about the fsg calls which
01:25:16 information about the fsg calls which they both realized was of the highest importance the decision to revoke stay put was taken in the control room at about 2 35 some 20 minutes after joe
01:25:28 about 2 35 some 20 minutes after joe smith had arrived in the control room and had assessed the worsting situation not taken immediately was taken 20 minutes afterwards it was taken by a station by joe smith in discussion with
01:25:39 station by joe smith in discussion with deputy assistant commissioner fenton mr sierra i have to ask you how you're getting on you've had more than quite a bit more than your uh well i noticed that i'm just approaching
01:25:51 well i noticed that i'm just approaching the conclusion which was luckily just creeping up on the screen at that moment very convenient thank you very much thank you for your patience here
01:26:02 so as i was saying that um that decision was taken by joe smith in consultation with a deputy assistant commissioner who
01:26:12 who had also had the benefit of seeing one side of the tower fully engulfed in fire on a tv in the brigade coordination center at about 2 33. those were senior officers whereas
01:26:23 33. those were senior officers whereas aom norman was a junior officer struggling in an understaffed under-resourced office without the situational awareness to be derived from a visual image of the fire
01:26:34 a visual image of the fire we therefore ask you to revisit those those criticisms and say that the control room staff including their supervisors were swamped and did their best in harrowing circumstances
01:26:45 their best in harrowing circumstances so to the conclusion sir we finished where we began reminding the gti of the importance of assessing the performance of the fire and rescue service in the wider political and economic context apportioning blame
01:26:56 economic context apportioning blame where it's due particularly in relation to those who created and enabled this truly horrifying disaster we accept there are important lessons to be learned by the lfb and the fire and rescue service
01:27:07 rescue service more generally from grenfell central government cfoa nfcc cfra and the lfb failed to equip and prepare operational crews instant commanders and
01:27:18 operational crews instant commanders and control staff for a major disaster such as grenfell it's essential there's a national body to oversee policy and guidance in the fire and rescue service including involvement from the trade unions the frontline professional
01:27:30 unions the frontline professional firefighters voice must be heard any changes or improvements to the fire and rescue service that may be recommended by the panel and we understand core participants are not being asked at this stage to suggest any
01:27:41 being asked at this stage to suggest any search but they will be given an opportunity in due course need to be properly resourced central government cannot deregulate privatize and cut away whilst at the same time increasing the duties of the fire rescue
01:27:52 increasing the duties of the fire rescue service
01:27:53 service eg regarding community fire safety but nevertheless expect the final rescue service to perform as if nothing had changed
01:28:01 changed it's bound to lead to deficiencies and mistakes
01:28:04 mistakes it mustn't be forgotten the lfb did not create the disaster through either the construction of a building or its subsequent refurbishment it failed in every way to protect the safety of its residents that was the legacy of a generation of
01:28:16 that was the legacy of a generation of central government policies allowing a profiteering free-for-all in the construction industry without any proper regard for safety whilst it's right that the lfb is held to account for its performance on the 14th of june 2017. it's wrong to
01:28:28 14th of june 2017. it's wrong to scapegoat a public service for a disaster created and made possible by others
01:28:33 others it's particularly wrong to blame the individual firefighters and control staff who attended the disaster in its early stages they did their best in line with their duty and their training and in our submission should
01:28:44 training and in our submission should not carry any part of the blame for the failings of the emergency response thank you for your patience and those few extra minutes thank you very much mr seawood well at that point i think we will take the afternoon break
01:28:57 will take the afternoon break and we'll resume at a quarter to four when we'll hear closing statement from mr walsh queen's council on behalf of the lfb thank you of course to four please
01:45:23 now the last closing statement in this series is going to be made by mr walsh queen's council representing the london fire again so
01:45:34 representing the london fire again so when you're ready mr walt
01:45:38 thank you uh very much uh sir good afternoon good afternoon is the founder mr at ball um you will not be surprised people you might be slightly relieved to hear me
01:45:49 might be slightly relieved to hear me say that i have no intention of attempting to address you uh on the entire contents of the london fire commissioner's 64-page closing statement which is obviously now a matter of public record
01:46:01 a matter of public record for anyone to read should they wish to do so
01:46:05 do so in any event much of its contents will be familiar to you from previous submissions on behalf of the brigade and that is because certain issues are of such importance
01:46:16 importance that they require restating or at least revisiting now that we've heard all the evidence reduced in modules five and six
01:46:25 and six but can i just make something clear because of some potential confusion which may have arisen from submissions that were made this morning
01:46:36 this morning in relation to the statement of the fire officers association the foa
01:46:43 can i make it very very clear that the london fire commissioner has repeatedly said that the brigade accepts the inquiries
01:46:54 that the brigade accepts the inquiries your your phase one recommendations and as i think you know is actively addressing them as we speak and has done for some time
01:47:05 for some time so the lfb does not the lfb does not ask you to revisit any of that
01:47:13 now statements from the fire officers association or indeed the fire brigade union the fbu as
01:47:22 as both of them national employee representation bodies are entirely separate from the london fire commissioner and the brigade so submissions that are made
01:47:34 the brigade so submissions that are made in those documents should not be attributed i mean it may be that sometimes there's agreement of course but but submissions in those statements should not be attributed to the lfc
01:47:45 should not be attributed to the lfc that neither of those bodies speak for the lfb or the london fire commissioner and they are entirely separate organizations and entities so there was a potential for confusion about
01:47:58 a potential for confusion about um to an extent conflating what the foa is saying with what the lfc is saying we want to make it very clear that they are very separate the lfb statement which you have
01:48:11 the lfb statement which you have sets out the position of the london fire commissioner on a wide range of issues among which are there are many others but among which are first of all
01:48:22 others but among which are first of all the accepted need for reform at the lfb locally
01:48:29 locally and also
01:48:30 and also nationally the approach to planning fire and rescue operations based upon the complex and very often naughty issue of foreseeability which is not a
01:48:43 issue of foreseeability which is not a binary issue as our representation achieved before the practical limitations and challenges faced by fire and rescue services when responding to fires in
01:48:55 when responding to fires in substantially failing buildings which were designed to sustain a stay put strategy
01:49:01 strategy and an account of the extensive work which the brigade has undertaken on policy procedure the use of equipment which has been informed by the brigade's
01:49:12 which has been informed by the brigade's own investigation following the fire and the resolute work of this inquiry which has informed the brigade a great deal in its lesson learning
01:49:23 deal in its lesson learning so for present purposes we would just like to touch upon a very few matters which really should be addressed to you already today and unlikely to take not much more than half an hour i hope
01:49:36 not much more than half an hour i hope first and foremost we must emphasize as must always be so that the london fire commissioner and those commissioners and senior staff who
01:49:47 those commissioners and senior staff who went before him feel deeply that the brigade owes it to the bereaved survivors
01:49:55 survivors and residents of grenfell tower and the vicinity and to the wider community to learn lessons from the tragic events of the 14th of june 2017
01:50:07 2017 learn lessons we've said this in some submissions to you so many times over the last four years that one tries to find uh different ways to express that
01:50:18 uh different ways to express that sentiment
01:50:19 sentiment and the genuine acceptance of responsibility which the lfc has repeatedly made for shortcomings which you sir expressed in your phase one report
01:50:31 in your phase one report and which certain of the inquiries experts have identified in their phase two reports of course the use or overuse of the phrase
01:50:42 phrase lesson learning in its various forms can be interpreted in all sorts of ways so what does it mean for the brigade it's best to use the commissioner's own
01:50:54 it's best to use the commissioner's own words
01:50:55 words during his evidence at the end of module six he described the cumulative failures which have been revealed during this inquiry on on the part of multiple organizations
01:51:06 organizations as quote
01:51:07 as quote the most appalling example of institutional failure i think in recent british history and we
01:51:15 and we the lfb
01:51:17 the lfb were part of that as well in in expressing himself so candidly he implicitly as well as explicitly on numerous other occasions
01:51:29 numerous other occasions acknowledged that the brigade needs to improve and work tirelessly to identify and implement improvements wherever possible and i will return to
01:51:42 and i will return to an account of what has been happening in recent years but of course that raises the question what part
01:51:51 what part of the broader failures which he referred to on the part of so many organizations was played by the lfb that is to say what could and should the lfb have done
01:52:04 what could and should the lfb have done better
01:52:07 now certainly as others have said uh it was not responsible the brigade for the failings which were exposed in modules one to three of phase two
01:52:18 modules one to three of phase two on the part of so many who were connected the refurbishment of the building
01:52:22 building which one must always remember precipitated the eradication of essential fire safety measures upon which residents and fire services rely and which in turn caused the devastating
01:52:34 and which in turn caused the devastating fire and contributed to the way it developed
01:52:39 i think
01:52:41 it was described in submissions this morning well that's just an obvious thing to say but i say it anyway but the lfc does
01:52:49 does frankly
01:52:50 frankly accept a number of shortcomings across a range of the brigade's undertakings from pre-planning information gathering to training
01:53:02 to training and indeed it's fair to say that a number of the witnesses in modules five to six those those former senior officers of the london fire brigade
01:53:13 fire brigade identified and accepted that there were shortcomings of themselves in relation to particular masses
01:53:21 some of those accepted shortcomings are set out in the written statement to which i have referred for example the findings of assistant commissioner jonathan smith
01:53:32 commissioner jonathan smith starting at paragraph 98 of the statement regarding practice and training in the control room but it could they could also be identified from the extensive remedial
01:53:43 identified from the extensive remedial work
01:53:44 work which has taken place since the fire and more recently
01:53:50 the severe consequences of the grenfell tragedy were also recognized by the commissioner during his evidence they are a constant reminder to him and to the brigade as a whole
01:54:01 the brigade as a whole of the pressing need to bring about meaningful change he pointed you may remember to the devastating impact on the bereaved survivors and residents and to
01:54:12 survivors and residents and to firefighters who were selfless in their efforts to respond to the fire despite the dangers which they faced at a fact which you sir of course recognized in your phase one
01:54:24 of course recognized in your phase one report for which the commissioner is extremely grateful he said this though i'm going to read a quotation out to him it actually doesn't it doesn't appear actually in the
01:54:35 it doesn't appear actually in the written statement so i'll just i'll just say that it's a day 1 213
01:54:41 day 1 213 first of december page 100 line 19 to page 102 line 2. he said this but all i know
01:54:53 but all i know is that my personal experience of the grenfell tower fire and the unimaginable impact it had on so many families and individuals and what it's done to my firefighters as
01:55:04 and what it's done to my firefighters as well
01:55:05 well they've had years now of being told that they did not do the job that they should have done
01:55:10 have done and in fact it is a great mistake i think not to recognize that the need for improvement in the institution does not relate to the courage and
01:55:22 does not relate to the courage and endeavor of those firefighters and it's been very difficult for them to hear this
01:55:29 he went on during his evidence to touch upon his military experience by drawing a comparison with the armed forces covenant with its own personnel
01:55:41 forces covenant with its own personnel but in relation to the the to the brigade extending its application to the community at large i quote again says this so i absolutely owe it
01:55:52 owe it firstly to the bereaved and survivors who in their dignity and their desire for answers have i think been an inspiration and i owe it to londoners
01:56:03 and i owe it to londoners because that is our job and it is our covenant and it is built into the dna of the organization we owe it to ourselves to challenge ourselves
01:56:14 ourselves continuously and then finally in relation to this quotation speaking of the range of work which the brigade has done in the last four years or so
01:56:25 four years or so he said i think the reason we've done it now
01:56:29 now is i'm afraid because the grenfell tower fire was the most terrible shock to the london fire brigade because i saw firefighters and officers put in a position that they should not have been put in
01:56:41 have been put in i saw the damage it did to the community and i think it's not just me i would not take the credit for the any of this i think it's through every level of the organization
01:56:52 organization there is an enormous desire to do right by the people who suffered the most
01:56:59 the most and to do right by londoners and by ourselves
01:57:03 ourselves you know the military again talk about a covenant with soldiers i think decent front line firefighters and officers deserve us to honour that government
01:57:14 government by bringing forward these improvements now
01:57:20 now those
01:57:21 those are extremely candid statements on behalf of the commissioner of the london fire brigade and the brigade is very firm in its assertion that that same level of candor
01:57:33 assertion that that same level of candor was demonstrated by other present and former london fire brigade staff when they came to give their accounts to you in both phases one and two
01:57:44 in both phases one and two and i wasn't necessarily going to but i am going to spend a little more time on the issue of canada in light of some submissions that you heard this morning
01:57:55 heard this morning none of them none of those witnesses we say sought any form of undertaking from the attorney general that their evidence to you would not be
01:58:06 that their evidence to you would not be used against them elsewhere they were frank and open many of those who gave evidence in modules five and six are now retired
01:58:17 modules five and six are now retired and in some cases they've been retired for quite a long time but they all expressed a genuine desire to assist the inquiry as best they could their collective approach reflects the
01:58:30 their collective approach reflects the open and transparent culture of the lfb as a public body the lfb is very aware of the need for transparency openness and candor as a public body
01:58:42 and candor as a public body and that openness was demonstrated we say through both both phases of the inquiry in which the brigade facilitated the attendance of over 80 personnel to give evidence in phase 1 and 15
01:58:55 to give evidence in phase 1 and 15 during modules 5 and 6 of phase 2 of this phase actually
01:59:01 actually um we made the point in the lfc's opening to phase one all the way back in 2018 that all of the lfb witnesses were expressly urged by the brigade not that
01:59:13 expressly urged by the brigade not that they needed to be but they were to be open and straightforward in giving evidence without any form of agenda save that it was imperative to learn the
01:59:24 save that it was imperative to learn the lessons that should be learned from watch manager dowden who was the first witness in the spring of 201 2018 giving evidence over three and a half days
01:59:37 evidence over three and a half days to the london fire commissioner himself in december of last year all
01:59:42 all we say co-operate cooperated fully and sought to answer the the inquiries questions to the best of their ability given their respective positions in a very large organization
01:59:53 very large organization uh uh
01:59:55 uh uh and in the context of the passage of time
01:59:59 time and i i i look i i i know i've said what i'm about to say before but i'm going to say it again now because it bears repeating in light of the submissions this morning
02:00:10 the submissions this morning on the question of candor openness and transparency apart from the disclosure of over 117 000 documents the brigade also devoted as you know
02:00:23 the brigade also devoted as you know substantial resources to the process of providing assistance to the inquiry particularly in phase one in many forms that exercise for those who need to be reminded of it
02:00:36 for those who need to be reminded of it included the complex task because it was complex of analyzing the huge body of evidence
02:00:42 evidence that that had been gathered by the lfb in an effort to piece together the clearest possible picture of the events of the night a series of operational response reports
02:00:53 a series of operational response reports were compiled for each of the first seven hours of the fire which provided a minutely detailed factual narrative second by second where possible of the actions of firefighters drawing
02:01:05 of the actions of firefighters drawing together key information from witness statements which were cross-referenced with breast breathing
02:01:11 breathing apparatus apparatus telemetry cctv and other media and a similar exercise was conducted in the preparation of a single control report which detailed the actions of officers
02:01:23 which detailed the actions of officers in the control room and as we have said in the written statement it is we believe fair to assert that it was substantially that body of evidence
02:01:34 evidence which informed the contents of the firefighting sections of the phase one report
02:01:39 report and your findings sir of course on a number of issues that was all the product of the brigade's open and candid approach to this inquiry well i turn now to an important question
02:01:53 well i turn now to an important question which has been the subject of some debate in the public arena can
02:01:58 can fire and rescue services provide a solution
02:02:02 solution complete or otherwise from an operational firefighting perspective to the failings of those concerned with the design construction and maintenance of high-rise residential buildings
02:02:15 high-rise residential buildings we appreciate that this is only one aspect of a much wider range of considerations which the lfp needs to address and which i'll dealt with in the written statement
02:02:26 written statement but it is of vital significance because this question impacts upon so many other factors
02:02:35 factors which concern operational procedure communications pre-planning risk information gathering and so on and it's also of national importance in the written statement
02:02:47 in the written statement we have repeated the basic principles of building design and safety requirements for high-rise resident residential premises with a stay put strategy
02:02:58 premises with a stay put strategy which of course emphasizes the importance indeed the necessity that the regulatory and legal requirements must be complied with if not to the letter at least broadly
02:03:10 not to the letter at least broadly we have also set out the challenges faced by fire and rescue services where these measures are substantially flouted ignored or wholly undermined for whatever reason
02:03:21 whatever reason when responding to fires in such premises
02:03:24 premises and we have addressed you at some length on a number of occasions previously on several of those aspects in previous submissions so today i'm going to try and approach it
02:03:36 i'm going to try and approach it differently in a short relatively short summary assuming for these purposes that a building in question has fallen
02:03:47 that a building in question has fallen well below the level of safety which the building regulations provide for and the stay put strategy described of course by dr lane and
02:03:58 described of course by dr lane and others quote as the single safety condition provided for in the design of high-rise residential buildings in england
02:04:06 england is wholly undermined the options available to fire and rescue services to mitigate such extensive failure inside fire safety provisions on the fire ground
02:04:18 the fire ground is extremely limited it would mean as we know only too well that the stay put strategy would need to be abandoned
02:04:30 be abandoned but as professor torreira says in his phase one report and i quote the means by which the fire service can alter the strategy are very basic by knocking on flat engine stores by
02:04:42 by knocking on flat engine stores by operating sounders within residence flats
02:04:46 flats and so on and all of these approaches he says
02:04:49 says are inconsistent with fire that has spread vertically or horizontally and that of course was the case grenfell tar
02:04:58 tar now
02:05:00 now those are problems that have to be overcome this is not an excuse for not doing anything but they are the reality that has to be overcome but when one combines that significant problem with the substantial challenges
02:05:12 the substantial challenges involving the physiological capacity of fire fighters and the duty of fire and rescue services to protect the safety of their employees which are set out in more detail in the
02:05:23 which are set out in more detail in the written statement fire and rescue services are placed with serious obstacles which they must try to overcome insofar as it is possible to do so
02:05:35 as it is possible to do so but the challenging of challenge of overcoming those obstacles is further hindered by the design of high-rise residential buildings which is dictated of course by the building
02:05:46 dictated of course by the building regulations according to certain assumptions and those assumptions include first only single unit fires are anticipated or allowed for well i take
02:05:57 anticipated or allowed for well i take this from from the inquiries experts of course it's just me saying multiple fires on multiple levels are not anticipated or allowed for vertical or lateral fires on the
02:06:08 vertical or lateral fires on the exterior are not anticipated or allowed for
02:06:12 for and simultaneous evacuation on a large scale
02:06:16 scale is not anticipated or allowed for indeed buildings of that kind are designed so as to inhibit mass i mean not to completely restricted
02:06:28 mass i mean not to completely restricted but certainly to inhibit mass simultaneous evacuation through the provision of only one single one stairwell without additional fire suppression systems or sprinklers and so
02:06:39 suppression systems or sprinklers and so on
02:06:40 on and the absence of building wide fire like firearms and the inability to alert residents and again so on so that's that's the position in other words
02:06:51 words the building regulations and this is the challenge for fire and rescue services and the wider regulator regulatory regime which governs the design construction maintenance of
02:07:02 design construction maintenance of high-rise residential buildings make no provision at all for the circumstances in which the single fire safety condition upon which the assumptions of the regulations are
02:07:13 the assumptions of the regulations are based
02:07:14 based is wholly undermined it isn't contemplated
02:07:20 in within the building regulations because broad compliance is assumed once local authority building control departments the bodies responsible for
02:07:31 departments the bodies responsible for ensuring compliance with the regulations certify compliance through the issue of a certificate
02:07:41 now it may be as we've said before that the significance of those challenges provides some some explanation for the absence of any guidance in national
02:07:51 national generic risk assessment gra 3.2 about how to formulate contingency plans for the evacuation of buildings of this kind
02:08:01 kind the continued absence of any such national guidance as many others have commented upon despite the ongoing work of the home office which has to be recognized as stephen mcgurk the inquiry's
02:08:12 as stephen mcgurk the inquiry's firefighting expert has observed underscores the real problems which exist in this regard but it's important that i make it clear that the the london fire commissioner does not offer the continued absence of national guidance
02:08:25 continued absence of national guidance as an excuse for the lfb's failure to develop such contingency plans prior to june 2017 because that's a matter for them but it is an important
02:08:36 them but it is an important consideration when looked at in a national context and we say that the issue may well be the subject of interesting further exploration with
02:08:47 of interesting further exploration with certain witnesses in module 6b which you are about to begin we just put a marker down as far as that is concerned uh so taking the position prior to and
02:08:58 uh so taking the position prior to and at the time of the grenfell tower fire mr mcgurk when he was addressing the effectiveness of the lfb's fire fire fighting on the night of the fire
02:09:09 night of the fire offers this view uh in his phase two report within that context external firefighting he says this paragraph 180 i would state that any evaluation of the
02:09:21 i would state that any evaluation of the effectiveness of external firefighting is extremely difficult
02:09:28 this is because of the multiple obstacles associated with design and access difficulties as well as numerous construction and building design failures but most especially the impact of the
02:09:41 but most especially the impact of the cladding
02:09:42 cladding these aspects are described in detail by dr lane's uh by dr lane says mr mcgurk in his sec in section 90 of her report so i don't propose to repeat her commentary here
02:09:54 propose to repeat her commentary here however
02:09:55 however i do emphasize the fact that the internal firefighting provisions of grenfell tower failed
02:10:03 failed simultaneously with the failure of virtually all other passive and active fire safety features that meant that the standard operational firefighting method normally employed
02:10:15 firefighting method normally employed for high-rise buildings by the lfb could not be implemented this presented says mr mcgurk a truly formidable challenge to the lfb especially to the first cruise
02:10:27 especially to the first cruise expressed simply he says grenfell quickly moved from being a compartment fire to a multiple to multiple compartment fires
02:10:37 fires to multiple compartment fires concomitant with the building itself being on fire the circumstances meant that any operational response was always going to
02:10:48 operational response was always going to entail extensive improvisation and he concludes this part of the the quote by saying i think it it is unreasonable therefore to suggest that the lfb ought to have
02:11:01 to suggest that the lfb ought to have anticipated an external fire of this nature and it is against this backdrop that my subsequent comments should be considered well
02:11:13 well so
02:11:13 so of course
02:11:15 of course the london fire brigade and other fire and rescue services around the country now at least must
02:11:24 must try to find ways to restrict or limit the need for improvisation when fighting fires of this kind it's it's it's something that the london
02:11:35 it's it's it's something that the london fire gave the commissioner and the brigade itself has been wrestling with and working very hard in consultation with the national fire chiefs council and the fire brigades
02:11:47 chiefs council and the fire brigades union and others and notwithstanding those challenges the
02:11:53 the commissioner's commitment to learning the lessons that can and must be learned from the grenfell tower fire is evident we say from the comprehensive improvement work that has been ongoing since june of 2017
02:12:07 that has been ongoing since june of 2017 improvement on this scale is challenging in an organization of the size and nature of the lfb with its demanding multi-faceted
02:12:18 with its demanding multi-faceted operational undertaking but much has
02:12:21 has been achieved through revisions of policy
02:12:25 policy procedure and training although there is more which the lfc seeks to accomplish through significant changes in organizational processes which i've addressed you on
02:12:36 processes which i've addressed you on before
02:12:38 before systems culture culture particularly and engagement which will strengthen the brigade's response to high-rise residential fires in the future and the need to ensure
02:12:49 in the future and the need to ensure the organization is capable of of effective change into the future is reflected in the creation of the new role of director of transformation
02:13:01 role of director of transformation in june of 2020 who is accountable for ensuring that sustainable change it's all about sustaining change across the organization is fully
02:13:12 across the organization is fully delivered
02:13:14 delivered and an extensive account of that work can be found in the london fire brigade improvement progress report of october 2021 prepared by
02:13:25 prepared by uh assistant commissioner andy bell with a summary and an update provided a paragraph 132 to 187 of the written
02:13:36 paragraph 132 to 187 of the written statement
02:13:37 statement the work is of course ongoing as the
02:13:42 as the commissioner explained in his evidence in december of last year but it remains his chief priority to ensure that the changes which have been set in train already are sustained into the future
02:13:53 are sustained into the future and reviewed regularly to keep pace with developments in the built environment and so before i conclude i think it's probably fair i should do
02:14:05 i think it's probably fair i should do this just to provide a few examples of that work which is the result of wide consultation with the national fire chiefs council and others as i have said
02:14:17 this is just a few examples but they're important ones the brigade has developed new and revised policies which address high-rise firefighting first
02:14:28 first evacuation second separately and fire survival guidance thirdly each of those policies which are closely interlinked
02:14:39 interlinked provide guidance and procedures for incident commanders and control staff to follow
02:14:45 follow including communication strategies in extreme circumstances of the kind experience at grenfell tower in relation to high-rise and evacuation
02:14:56 in relation to high-rise and evacuation the brigade delivered face-to-face theory training to approximately four and a half thousand
02:15:04 thousand staff
02:15:05 staff within a year during the panda pandemic and that involved attending a day-long exercise session which was partly appliance-based and was designed to replicate through
02:15:17 and was designed to replicate through role-play with the involvement of the control room the management and passage of large numbers of fsg calls and this is being followed
02:15:28 and this is being followed by large scale exercises to which all of the officer cohort is invited which are designed to place incident and other commanders into
02:15:39 incident and other commanders into situations barring actual flame which are as real as possible by for example using smoke generation and simulated casualties and that sort of thing and to date the brigade has run
02:15:51 of thing and to date the brigade has run five large-scale exercises and a further 18 are scheduled to take place by the end of may of this year further policy developments address risk
02:16:04 further policy developments address risk information gathering and incident command while extensive work has been carried out to improve information sharing between the brigade specialist fire safety and engineering department and
02:16:16 safety and engineering department and operational staff that as we know from the work of this inquiry
02:16:21 inquiry is absolutely key and the the commissioner accepts that it is important to i know what was meant when the word silo was used this morning but one has to
02:16:32 was used this morning but one has to one has to bring the different departments of such a large organization such as the lfb together so that there is communication between them and that's what that part of the
02:16:43 of the the programme of reform is seeking to achieve
02:16:46 achieve the changes to operational risk information gathering are there intended to enable crews to be more familiar with the built environment in their on their station ground
02:16:57 station ground and recent training to all operational staff has meant that they it is hope they are better able to recognize the signs of building failure and to put appropriate mitigations in
02:17:08 and to put appropriate mitigations in place in the context of the new policies in the field of incident command training the commissioner has established a dedicated incident command training team
02:17:20 training team to ensure that there is a consistent consistency of training through command unit crews and the control room uh facilitating more effective lines of
02:17:31 uh facilitating more effective lines of communication in that regard and
02:17:35 and as i'm sure you would expect there has also been a very significant restructuring of training in the control room
02:17:44 room as part of the brigade's control improvement plan
02:17:49 and then just one or two other matters a number of changes to incident communications importantly have also been implemented with the use of a wider range of radio channels
02:18:02 of a wider range of radio channels and the procurement of new fire ground and breathing apparatus communication equipment which is to come online this year and there have been enhancements also in a range of other operational
02:18:14 also in a range of other operational equipment including the continued use of escape hoods uh fire hoods which the lfb having was the first to introduce them in the
02:18:25 the first to introduce them in the country
02:18:26 country after the
02:18:28 after the after the fire itself then there are new 32 meter and 64 meter turntable ladders and just as another example the development and the use of drones
02:18:40 development and the use of drones with thermal imaging capabilities all of those matters have come in into train uh since
02:18:47 uh since uh the fire and since the work at the since the grenfell tower fire but those are only small examples actually of the much wider piece of work so in conclusion the question
02:18:59 the question whether the london fire brigade is a learning organization was
02:19:04 was addressed to a large extent by past and present
02:19:07 present senior officers who gave evidence in modules five and six when they were given then an opportunity to explain the challenges and in some cases the realities of providing
02:19:19 cases the realities of providing firefighting and rescue services in one of the most populous and complex and densely built cities in the world but as the lfc made clear in his evidence towards the end of phase one
02:19:32 evidence towards the end of phase one large communications must always develop policy and procedure through learning from experience we now know it needs more than just experience but
02:19:43 experience but that is the sentiments and that culture must be embedded he says and never ending
02:19:50 ending he
02:19:51 he commissioner rowe is determined to ensure that the london fire brigade is proactive in its approach particularly with regard to the increasing complexity of modern
02:20:02 increasing complexity of modern construction and design methods and materials in so far as the impact on fire safety and the wide-ranging and comprehensive improvement work which we as i've said
02:20:14 improvement work which we as i've said is only briefly summarized today has been ongoing now for some time however
02:20:21 however the commissioner made it clear during his evidence at the end of module six
02:20:26 six that the question whether the lfb has learned from grenfell tower and that tragedy can only be answered in accordance with the outcomes
02:20:38 the outcomes the brigade delivers to london the brigade is we say
02:20:45 we say it's about that business it's going about that business and trust itself to do so
02:20:51 do so thoroughly but i'll leave the last word to the commissioner he said in his evidence to you so i don't ask for trust
02:21:03 so i don't ask for trust i don't think we deserve to ask for trust
02:21:07 trust until we demonstrate different outcomes i think he said we are beginning to do that so those are my closing submissions on behalf
02:21:19 closing submissions on behalf well thank you very much you mr walsh
02:21:23 well that completes the oral statements that we were expecting to hear today and indeed
02:21:30 indeed at this stage in the proceedings we had set aside a few more days for oral statements because we thought that there might be other core participants who would wish to address us but as it turns out that
02:21:43 to address us but as it turns out that time
02:21:44 time will not be required so we shall not be sitting for the rest of this week the hearings will continue on monday of next week 31st of january
02:21:55 on monday of next week 31st of january 10 o'clock as usual when we shall resume hearing evidence in module 6. so
02:22:02 so at that point we shall rise and we shall look forward to seeing those of you who wish to attend here on monday of next week thank you very much
02:22:26 you