Grenfell Tower

What happened?

On 14th June 2017, an electrical fault in a fridge freezer in apartment 16 on the 4th floor of Grenfell Tower in London led to a fire in the kitchen of this apartment. A modest kitchen fire such as this was perfectly foreseeable. However, a sequence of events following the failure of this common domestic appliance led to disastrous consequences, resulting in the deaths of 72 residents of Grenfell Tower. This is the largest loss of life from a single event in the UK since the Hillsborough stadium disaster in 1989.

Within 15 minutes of a call to the emergency services (at 00:54am), who attended rapidly, the fire had reached the cladding on the exterior of this apartment and started to climb the building. Less than 20 minutes later, the fire climbed 19 floors to reach the roof of the building and then started to spread down the sides, entering multiple apartments. The entire building of 24 storeys was enveloped by fire in under three hours. The last survivor to leave the Tower was evacuated at 08:07am.

In researching this article, I have reviewed the Grenfell Tower Inquiry Phase 1 Reports. The four volumes total 856 pages, and so I have necessarily constrained my article to discussing selected human and organisational factors. Full details, including the technical aspects, can be found in the Reports. I will focus here on the incident response, the right-hand side of the bowtie; rather than the events leading up to the use of flammable cladding on the exterior of the building.

Although the Inquiry considers the decisions and actions of many individuals during the event, any shortcomings in the incident response were considered to be mainly systemic in nature.

At the time of writing (October 2023), the Inquiry is still progressing and official updates can be found at https://www.grenfelltowerinquiry.org.uk/.

How did the fire spread so rapidly?

The Inquiry concludes that the aluminium composite material (ACM) rainscreen panels on the outside of the building acted as a source of fuel. These panels contained a highly flammable polyethylene core. The combustible foam insulation behind these panels contributed to the rate and extent of vertical flame spread. This cladding had been recently added to the building, which was constructed of reinforced concrete. (Although completed in 1974, the building was extensively refurbished between 2012 and 2016). An architectural ‘crown’ on the roof, also made of cladding, helped to spread the fire to other sides of the building.

None of the firefighters attending this event had received any training on the risks posed by such exterior cladding, or training on techniques for fighting fires involving cladding. This is surprising, given previous fires involving cladding on high-rise buildings (for example, Knowsley Heights 1991, Garnock Court 1999, Shepherd’s Court 2016). Following the Shepherd’s Court fire, London Fire Brigade wrote to the Chief Executives of all London boroughs, with a letter that was headed “Tall Buildings – External Fire Spread”.

Several witnesses from London Fire Brigade (LFB) stated that they did not understand what was happening as the fire spread rapidly up the outside of the building. Very few (if any) of the senior officers who attended Grenfell Tower were aware of the risks posed by exterior cladding.

Although the risks of rapidly developing fires on the exterior of high-rise buildings, and the consequent deluge of emergency calls, were well-known to the LFB prior to this tragedy, this knowledge had not informed firefighting policies, practices or training.

The failure to train firefighters in how best to fight cladding fires was an organisational failure by the London Fire Brigade. This contributed to a failure to control the fire, or make timely strategic decisions about rescue and evacuation.

The intensity of the heat from the external fire caused glass in the windows to fail, allowing the fire to spread into other apartments (known as ‘flats’ in the UK).

The basis of much fire-fighting strategy in high-rise residential buildings is that fires can be ‘compartmentalised’ or contained within the compartment where the fire first starts, until extinguished by firefighters. However, in this case, effective compartmentation was lost at an early stage – but this was not known or acted upon. The fire on the outside of the building quickly entered many apartments and the smoke spread rapidly through the interior. A lack of awareness that compartmentation was lost had a significant impact on the effectiveness of the firefighting strategy.

Related to the concept of compartmentation is the advice given to residents of high-rise buildings. There was a clear mindset that residents should remain in their homes (known as ‘Stay Put’), with the assumption that they would be rescued by firefighters. The advice to ‘Stay Put’ relied heavily on this assumption. As the situation at Grenfell Tower developed, the Inquiry argues that it would have been appropriate to explore early options for evacuation.

These two related principles of compartmentation and ‘remaining in your property’ are often used to justify a single stairwell in tall buildings such as Grenfell Tower.

Incident response

The many firefighters who attended this event displayed enormous courage. And when analysing the evidence, the Inquiry is very aware of the benefit of hindsight and access to information that was not available to key personnel at the time, who were clearly acting under very difficult circumstances.

For context, note that the initial crews attending were called out to a small domestic kitchen fire in a lower-floor apartment of this high-rise residential block. They had little reason to expect the incident to escalate so rapidly and catastrophically. As we shall see later, the escalation of this small fire was outside the experience and training of those attending.

There is no doubt that the firefighters responding to this event soon faced an extremely difficult scenario, in a multi-storey building with multiple fires, and as we now know, several failures of fire protection systems. But they were ill-prepared for the nature, speed and ferocity of the fire that developed.

“However, hindsight provides no answer to the significant systemic and operational failings revealed by the evidence. The bravery and commitment to duty shown by individual firefighters cannot mask or excuse the deficiencies in the command and conduct of operations”

The Grenfell Tower Inquiry: Phase 1 Report, Volume 4, 2019, p.596

Given the hundreds of firefighters who attended over a prolonged period, it’s only possible to discuss here selected issues relating to the incident response.

Command, control and communication

Several Incident Commanders were in control at different times, their role being to direct operations on the ground. They create an operational plan, make dynamic risk assessments, assess the need for additional resources, and establish a command and communications structure. As the incident severity or complexity increases, more senior officers may take this command role, following a handover.

In addition to finding themselves in a situation that was outside of their training and experience, initial Incident Commanders were considered not to have received the support from senior officers that would be expected.

More senior and more experienced officers did not take command on arrival (contrary to LFB policy), and the Inquiry is critical about the lack of decision-making or practical support provided by these officers (for example, relating to fire control, evacuation, or deployment of incoming resources).

Command was passed to several officers, some of them only in this role for a short period. The Inquiry notes that handovers between commanders were brief, and failed to communicate key information such as the number of emergency calls or their prioritisation. There were also communication failures between the Incident Commanders themselves. And at one point, there were two Incident Commanders operating separately, unknown to each other. Those in command failed to seek critical data to inform their strategy, made “unverified and erroneous assumptions” (Vol.4, p.611) and in some cases are described as being out of touch with the situation.

The Inquiry concludes that until an Assistant Commissioner arrived on scene and took command at 02:43am, none of the previous Incident Commanders had effectively seized control of the situation. This senior officer immediately considered that there had been a total failure of compartmentation and revoked the ‘Stay Put’ advice. At this point, a full evacuation was no longer practicable due to the deterioration in conditions on the stairs.

The Inquiry comments extensively on inter-agency communications, and concludes that the principal flaw was communication, both at control room level and on the ground, such that “individual organisations were often working in isolation and in ignorance of what the others were doing” (Vol.4, p.697).

For example, the Metropolitan Police Service, London Fire Brigade, and London Ambulance Service all declared the scene a Major Incident at different times (01:26, 02:06 and 02:26 respectively). Each emergency service made this declaration (which, for example, leads to more resources) without knowing whether other services had already done so.

There was no communication between senior officers from the three emergency services at the scene until well into the incident, at the earliest this was 02:23am. The LFB did not inform the other emergency services about the decision to abandon the ‘Stay Put’ advice in a timely manner. The Police were informed of this key change in strategy at 03:08am, and the Ambulance Service at 03:20am.

‘Stay Put’ or evacuate?

This was an area of significant discussion in the Inquiry, who concluded that there was a point when an evacuation of the building would have minimised the number of casualties.

The ‘Stay Put’ strategy traces it origins back to 1960’s British Standards. As buildings started to become higher than the reach of mobile firefighting ladders outside the building, it was recommended that buildings be designed such that residents can remain in their dwelling, rather than evacuate or be rescued.

British Standards guidance to residents is that if there is a fire elsewhere in the building, they would normally be safe in their own apartment, with windows and doors closed. They are advised to leave immediately if smoke or heat enters their home. This guidance is usually given to residents in tenancy agreements, and posted around common areas of the the building.

The single stairway in Grenfell Towers was still passable until around 01.30am to 01.50am, and many residents left the building during this time – ignoring the advice to ‘Stay Put’. A total of 112 people had left the building within 35 minutes of the first 999 call.

The strategy to ‘Stay Put’ relies upon a certain level of passive and active fire safety systems being in place, and that residents are fully aware of safety systems and arrangements in the building (such as fire resistant doors). It is also key that passive fire protection is maintained during any refurbishment. Although newer high-rise buildings will be fitted with fire suppression systems, older properties may not have these installed – and building owners can argue that retrofitting such systems is not practical or economically viable. Grenfell Towers had no fire suppression (sprinkler) system.

The London Fire Brigade (LFB) has access to national guidance for fire and rescue services that clearly stipulates the need to re-evaluate the ‘Stay Put’ advice and to consider partial or full evacuation. In order to enact this high-level guidance (e.g. Generic Risk Assessment 3.2), the LFB would be expected to provide appropriate training for Incident Commanders (including how to decide when compartmentation has failed and/or when evacuation is appropriate).

The Inquiry is firm in its conclusion that the LFB commanders on scene failed to recognise the rapidly increasing risk to life and failed to revise their strategy. I note that the Inquiry is fully aware of hindsight bias, but it stresses the key information that was available to LFB command. For example:

• Firefighting was failing to contain the fire
• The fire was spreading rapidly externally
• Residents were leaving in substantial numbers
• Evacuating residents were suffering from smoke inhalation
• The number of pumps in attendance was increased in 3 steps from 15 to 25 within just 2 minutes
• The Commander sent a “persons reported” message at 01.28 (i.e. trapped by fire).

“Once it was clear that the fire had spread out of control, that compartmentation had extensively failed, but that evacuation remained possible, a decision should have been made to evacuate the tower”

The Grenfell Tower Inquiry: Phase 1 Report, Volume 4, 2019, p.596

However, at several points in the Inquiry reports, there are references to the firefighters being unprepared for such a scenario given their experience, training and policies. The evidence shows that training failed to prepare Incident Commanders with the means of deciding to switch from the ‘Stay Put’ strategy to one of partial or total evacuation.

There is also no evidence that any of the officers who attended (with perhaps one exception) had received any training in the principles of evacuation from high-rise buildings, how to decide whether evacuation was necessary, or how to carry it out safely and efficiently. These failings were institutional in nature.

I also note that the Inquiry states that revoking the ‘Stay Put’ policy and implementing an evacuation order would have required “a cool head and a great amount of self-confidence” (Vol 4, p.602). Evacuating the building would be logistically difficult, with no means to easily or reliably communicate with all residents (there was no building fire alarm or public address system). If the ‘Stay Put’ policy was considered to be untenable, the Incident Commander would be improvising – clearly not ideal in this very complex scenario. These difficulties were stressed by the LFB Commissioner in her evidence to the Inquiry:

“It’s all very well saying ‘Get everybody out’, but then how do you get them all out?”

London Fire Brigade Commissioner, Witness statement, MET00012492, p.38

The decisions of the various Incident Commanders were supported by other, more senior firefighters on scene. This was therefore a systemic issue across London Fire Brigade, and not a failure on the part of the individuals present.

When the ‘Stay Put’ advice was withdrawn at 02.47am, the situation had worsened considerably.

The Inquiry concluded that an earlier attempted evacuation would have been preferable to continuing to tell residents to stay in their homes. The Inquiry, however, does acknowledge that an evacuation would give rise to dangers, including a risk to life of residents and firefighters.

To summarise – there was no clear LFB policy for evacuation, no training for high-rise building evacuation, no building evacuation plan in place, no means to easily contact residents, and the Brigade had a strong ‘Stay Put’ policy.

A note on ‘culture’

Although the Inquiry does not explicitly discuss culture, one definition of this concept relates to ‘accepted practice’, and this is relevant here. The ‘Stay Put’ concept is so ingrained in the Fire Brigade culture, that any departure from it is described by the Inquiry as unthinkable. Residents staying in their dwellings, awaiting rescue, is simply what is expected and trained for. Stepping outside of this framework would have required a considerable shift in thinking and behaviour, for which the crews were ill-prepared.

Commentators have also suggested that individual firefighters may have concerns around liability should they deviate from the ‘Stay Put’ advice – particularly as they may be unaware of the national guidance that allows for the ability to reconsider this advice, if evacuation becomes appropriate.

Situation awareness

The Incident Commanders lacked certain operational information, which influenced their decisions. For example, they were unaware of the number of calls from residents to the emergency control room, including a large number of these being persons trapped and affected by fire, heat or smoke. The rate of these Fire Survival Guidance calls (‘FSG’ calls – where the control room operator stays on the line) was increasing rapidly and, importantly, they were from different areas of the building (indicating that no part of the building was or would remain safe).

“The practical consequence was that, as incident commander at a dangerous fire which was already out of control, [Incident Commander] was not aware of current conditions within the tower or of the number and location of residents who considered themselves to be trapped”.

The Grenfell Tower Inquiry: Phase 1 Report, Volume 4, 2019, p.601

According to the Inquiry, the Incident Commanders failed to seek or receive reports about the conditions in the building lobbies and the stairs higher up in the building. They were also not in contact with the Police helicopter who could have provided information on the spread of the fire to other sides of the building, or the residents seeking rescue there. Commanders did not obtain a full understanding of the situation, whether from emergency calls, front-line firefighters, the control room, or the helicopter.

The failure of Incident Commanders to seek relevant information or appreciate the significance of information available is also considered to be due to inadequate training.

The London Fire Brigade Operational Response Database (ORD) contains basic information about the building to support firefighting. However, the Database available to crews attending Grenfell Tower contained minimal and inaccurate information about the Tower itself and no tactical plan for fighting the fire. Several deficiencies in the Database were stated by the Inquiry to have rendered it woefully inadequate. And on the night of the fire, the Incident Commanders did not have access to any plans of the building until very late in the incident.

Communications

Information from, or about, 999 callers from the Tower was not managed effectively (‘999’ is the emergency number in the UK). The Fire Brigade’s system for managing Fire Survival Guidance (FSG) messages on the incident ground was inadequate (note that the same conclusion was made following the Lakanal House fire in 2009).

For example, Commanders were not aware of the number or location of these callers, whether they had been rescued, or whether the control room had been updated on the response. The failure to manage the details of these callers on site, even after multiple 999 calls, meant that no rescue attempts were made for some families, with fatal consequences. Several residents waited in their homes for help that did not arrive. This is a fundamental failure of fire service command and control.

To illustrate the inadequacies in this system, the Inquiry outlines in some detail the communications and information flow relating to one family (Vol.4, p.622-625). All five members of the family died in their apartment and, like many other sections of the Reports, this is an upsetting read.

The Inquiry makes several damning statements about the system for managing this FSG information, concluding that these defects had serious consequences:

“The chaotic nature of the communication links meant that neither the control room nor the command units nor the incident commander could know whether rescue attempts had been made in response to calls, or if they had, what had been the outcomes”.

The Grenfell Tower Inquiry: Phase 1 Report, Volume 4, 2019, p.621

Control room challenges

The control room personnel that night received an unprecedented number of 999 calls, which was described as a “challenge wholly outside their experience and training” (Vol.4, p.635). Their courage and calmness saved many lives. Some of these personnel had been on duty during the Lakanal House fire (2009) and taken calls from those residents.

Despite the unusualness of the Grenfell Tower tragedy, in a large city such as London with many similar buildings, these challenges could foreseeably be repeated. The investigation into the Lakanal House fire made several critical conclusions relating to the control room response, and the current Inquiry states that they all apply in this case – and that few lessons were learnt by the London Fire Brigade. For example, the LFB were unprepared for an event involving a large number of FSG calls, despite the lessons which were said to have been learnt from Lakanal House.

The LFB control room received a large number of calls (about 120) from residents of the Tower and many calls from members of the public. They quickly became overwhelmed with calls around 20 minutes after the fire had broken out of the initial flat. Several of these calls were from residents many floors above the original fire, and included calls where the residents were trapped by fire. Even at this point, several of the calls reported the whole building on fire.

By 01:50am, the control room had received multiple calls from several of the residents, and 20 of these were callers who reported being trapped by fire, heat or smoke (including on the highest floors). The control room policy was to stay on the line with these callers, including to provide advice (Fire Survival Guidance). At this time, 168 of the 297 occupants of the building had escaped (against the ‘Stay Put’ advice).

The LFB’s own guidance states that the information available to Control Room Operators (CROs) may be more accurate and informative than that available to Incident Commanders on scene. These roles are clearly critical to an effective firefighting response and can pass key information to the on-ground Incident Commanders. However, they also need to receive updates from the scene to be most effective in their role. In this event, they did not receive information that the fire had spread from the apartment of origin and therefore continued to give incorrect information and advice to callers. The CROs were left to “piece together a confusing and often incomplete picture” (Vol.4, p.621).

Due to incomplete information, the CRO’s ‘mental model’ of the fire was incorrect. Similar to the Incident Commanders (as described above), the CROs also had poor situation awareness, which influenced their decisions and actions. These CROs – the individuals who spoke with many residents in distress – often did not know whether firefighters had been dispatched to rescue those residents.

At 02:35am, senior personnel in the Control Room made a decision to advise all residents to leave. This decision was based solely on information from 999 callers, which convinced them that nowhere in the building was a safe refuge. The same decision was made on the incident ground at 02:47am.

Failure to learn from previous events

Several previous incidents and Government reports are relevant to understanding the Grenfell Tower tragedy. In examining the firefighting response at Grenfell Tower, it’s helpful to review two previous major fires to understand key lessons – and whether they were learnt.

The fire risks from cladding the external walls of high-rise buildings had been identified in the 1980s, for example in reports by the Building Research Establishment (1986), which refer to combustibility of materials used in insulation or over-cladding.

In their submission to the report on “Potential risk of fire spread in buildings via external cladding systems” by the Select Committee on Environment, Transport and Regional Affairs, the Fire Brigades Union outlined the risks from cladding (18 years before the Grenfell Tower disaster) and stated that:

“The primary risk therefore of a cladding system is that of providing a vehicle for assisting uncontrolled fire spread up the outer face of the building, with the strong possibility of the fire re-entering the building at higher levels via windows or other unprotected areas in the face of the building. This in turn poses a threat to the life safety of the residents above the fire floor”

Fire Brigades Union, 20 July 1999

The Garnock Court fire, 1999

On 11 June 1999, a fire in this 14-storey block of apartments in Scotland led to the death of a resident and injured several others.

Following this fire, a UK Parliament Committee report discussed the potential risk which could be posed by fire spread involving external cladding systems. The risks included a shorter period available for escape from the building, and disproportionate difficulties in firefighting. This report also refers to a fire in a tower block in Knowsley (1991) that started at ground floor level and spread up 11 floors behind rainscreen cladding. It concludes that external cladding should be entirely non-combustible, or proven not to pose an unacceptable level of risk in terms of fire spread (and noted that current small-scale tests are inadequate). This report also recommended a review of how many properties with external cladding systems do not comply with current Regulations.

“We do not believe that it should take a serious fire in which many people are killed before all reasonable steps are taken towards minimising the risks”

Potential risk of fire spread in buildings via external cladding systems, Select Committee on Environment, Transport and Regional Affairs, 1999, para 19

Lakanal House fire, 2009

Six residents, including three children, died in a fire at Lakanal House, Camberwell, on 3 July 2009. This event is comparable to the Grenfell Tower tragedy in many ways. The fire was also started by a domestic appliance – in this case, a television on the 9th floor. And the effects of the fire spread to many other apartments in the 14-storey building.

I reviewed the Coroner’s Inquisition and Narrative Verdicts relating to the six residents who lost their lives inside Lakanal House. From these reports, it can be seen that several years prior to the Grenfell Tower fire, there are key lessons; for example, in relation to the external spread of the fire from one home to the next:

“The fire spread up into Flat 79 through the panels under the bedroom windows of Flat 79. The aluminium window frames were distorted by the flames from Flat 65, creating gaps through which the curtains of Flat 79 caught alight. . . . The panels under the bedroom windows of Flat 79 were not Class 0, although they required to be. This was due to a serious failure on the part of SBDS, its contractors and its subcontractors”.

Coroner’s report for Catherine Hickman, 28 March 2013 (Lakanal House fire)

Given the use of flammable cladding in the refurbishment of Grenfell Tower, a recommendation from the Lakanal House Coroner is key – “particular regard be given to the spread of fire over the external envelope of the building and the circumstances in which attention should be paid to whether proposed work might reduce existing fire protection”.

Clearly, concerns about the contribution of external cladding systems to fires on high-rise buildings are not new.

The Inquiry into Grenfell House has concluded that:

“Following the refurbishment, the external walls of the building did not comply with the Building Regulations because they did not adequately resist the spread of fire over them. On the contrary, they promoted it”

Sir Martin Moore-Bick, Chairman of the Inquiry, video statement on 30 October 2019

In the Lakanal fire, similar to Grenfell Tower, there was also a serious failure of compartmentation – in other words, the fire spread from one apartment to the next, partly due to a lack of fire seals on front doors and inadequate fire resistance from previous renovations. Several residents sheltered in bathrooms, but the interconnected bathroom ventilation ducts led to some becoming overcome by smoke coming from other apartments. Several people sustained fatal injuries whilst waiting to be rescued in their bathrooms.

The advice to ‘Stay Put’ is only appropriate if the fire cannot spread. Unfortunately, in both Lakanal House and Grenfell Tower, the fires did spread.

In relation to the Lakanal House fire, the Grenfell Tower Inquiry concluded that it had:

“. . . justified concern that the LFB [London Fire Brigade] as an institution had failed to learn or put into practice the lessons of that event”.

The Grenfell Tower Inquiry: Phase 1 Report Overview, 2019, p.22

Overall conclusion on the fire-fighting response

It is noted that, although there may be criticisms about the role of the London Fire Brigade as an organisation, the individuals who responded to this tragic event did so with immense bravery, and to the standard that their training and experience allowed. This sentiment is repeated by the Chairman of the Inquiry.

However, after reviewing the evidence, Sir Martin Moore-Bick concluded that:

“I consider that these represent significant systemic failings in the organisation of the LFB and show that it had failed to learn the lessons of the Lakanal House fire”

Sir Martin Moore-Bick, Chairman of the Inquiry, video statement on 30 October 2019

Wider socio-political causes

The UK Fire Brigades Union (FBU) published a report called “The Grenfell Tower fire: a crime caused by profit and deregulation” (2019). This report pulls no punches – it focusses on systemic failures by Government:

“The FBU believes that the terrible loss of life at Grenfell Tower was ultimately caused by political decisions made at the highest level. For at least 40 years, policies relating to housing, local government, the fire and rescue service, research and other areas have been driven by the agenda of cuts, deregulation and privatisation”.

Fire Brigades Union, 2019, p.3

This FBU report points to several successive Government initiatives to reduce the ‘burden on business‘ by reducing the number of regulations – such as the ‘Red tape challenge’ announced by Prime Minister David Cameron in 2011. Regulation, including building safety regulation, was seen as a barrier to economic growth.

I researched Government media releases from this period, and in 2012 David Cameron stated:

“And there is something else we are doing: waging war against the excessive health and safety culture that has become an albatross around the neck of British businesses. . . So this coalition has a clear New Year’s resolution: to kill off the health and safety culture for good. I want 2012 to go down in history not just as Olympics year or Diamond Jubilee year, but the year we get a lot of this pointless time-wasting out of the British economy and British life once and for all”

‘Business boosting measures announced’, Prime Minister David Cameron, 5 January 2012

At the time, I was a health and safety inspector in the UK Health and Safety Executive (UK HSE), and our Department was impacted by these initiatives. Along with austerity measures that cut funding to key services, the FBU argues that deregulation impacted the safety of London residents.

In response to the Grenfell Tower tragedy, key health and safety organisations called on the Government to end the deregulation of health and safety legislation in an open letter to the Prime Minister, Theresa May.

Final thoughts

I have attempted to summarise a significant amount of information available on this tragedy, and can only extract selected human factors and organisational issues in this article. And as the investigations continue to progress, more materials will become publicly available. Of the hundreds of pages of Inquiry reports, witness statements and other documents that I have reviewed in writing this article, one paragraph remained in my thoughts:

“Quite apart from its remarkable insensitivity to the families of the deceased and to those who had escaped from their burning homes with their lives, the Commissioner’s evidence that she would not change anything about the response of the LFB on the night, even with the benefit of hindsight, only serves to demonstrate that the LFB is an institution at risk of not learning the lessons of the Grenfell Tower fire”.

The Grenfell Tower Inquiry: Phase 1 Report, Volume 4, 2019, p.607

Further information

The Phase 1 Report of the Grenfell Fire Inquiry was launched with a video statement by the Chairman of the Inquiry, Sir Martin Moore-Bick. This statement, approximately 12 minutes in duration, provides a useful summary of this Phase 1 Report.

Report of the Public Inquiry into the fire at Grenfell Tower on 14 June 2017. Grenfell Tower Inquiry, Phase 1 Report – Overview, The Rt Hon Sir Martin Moore-Bick, 30 October 2019. This short report contains three chapters from the full Phase 1 Report – an Executive Summary, the Recommendations and a Look Ahead to Phase 2 of the Inquiry.

Report of the Public Inquiry into the fire at Grenfell Tower on 14 June 2017. Grenfell Tower Inquiry, Phase 1 Report – Volume 1, The Rt Hon Sir Martin Moore-Bick, 30 October 2019. Contains the first eight chapters of the Report, outlining the background in some detail.

Report of the Public Inquiry into the fire at Grenfell Tower on 14 June 2017. Grenfell Tower Inquiry, Phase 1 Report – Volume 2, The Rt Hon Sir Martin Moore-Bick, 30 October 2019. Contains the events of 14 June 2017 from 00:54am to 02:20am.

Report of the Public Inquiry into the fire at Grenfell Tower on 14 June 2017. Grenfell Tower Inquiry, Phase 1 Report – Volume 3, The Rt Hon Sir Martin Moore-Bick, 30 October 2019. Contains the events of 14 June 2017 from 02:20am to 08:10am.

Report of the Public Inquiry into the fire at Grenfell Tower on 14 June 2017. Grenfell Tower Inquiry, Phase 1 Report – Volume 4, The Rt Hon Sir Martin Moore-Bick, 30 October 2019. Contains Conclusions around the fire, the response and Recommendations. Also contains a celebration of the lives of those who died, based on the Commemoration Hearings in May 2018.

The Grenfell Tower Inquiry. The Inquiry, chaired by Sir Martin Moore-Bick, was created to examine the circumstances leading up to and surrounding the fire at Grenfell Tower on the night of 14 June 2017. This website contains transcripts of Hearings, videos, key documents, news and Inquiry Reports. Please note that materials on this site include content which viewers or readers may find upsetting or distressing.

“Grenfell Tower: The 21st floor”. A BBC Newsnight production (the link below may not be available in all regions). The BBC also created an online print version of this video, dated 28 September 2017.