Grenfell Tower inquiry: expert explains four main findings – and how emergency services must improve

Focus on the fire service. John Gomez/Shutterstock.

Paresh Wankhade, Edge Hill University

The long-awaited phase one report of the public inquiry led by Sir Martin Moore-Bick into the fire at the Grenfell Tower has been published. This report examines the events of an extremely complicated situation on the night of June 14, 2017, which resulted into the tragic loss of 72 lives. It investigates the cause of the fire, how it developed and the steps taken by the London Fire Brigade (LFB) and other emergency services.

Understandably, the response to the findings – which underscore failures by emergency services – has been immediate and intense, with survivors calling for the resignation of London Fire Brigade chief Dany Cotton. Yet the report runs over 830 pages, and it will take time to examine and understand the findings in detail. For now, I’ve drawn on my expertise in the management of emergency services to summarise the report’s key findings and recommendations.

1. Require owners and managers to share information about building design and materials.

Similar cladding was found on Chalcots Estate in Camden, London. mattbuck/Wikimedia Commons.

While the report was critical of the fact that LFB was unaware of the combustible nature of the materials used in the external cladding that surrounded Grenfell Tower, it concluded that the cladding was largely responsible for the fire spreading so quickly.

The report recommends that owners and managers of every high rise residential building (over 18 metres in height) should provide their local fire and rescue service with information about the design of its external walls and details of the materials of which they are constructed. This is a significant recommendation, which should help local fire services to recognise the nature of each fire they face, and make contingency plans to deal with specific types of fires.

2. Develop national guidelines for the evacuation of high rise towers.

Moore-Bick praised the firefighters who attended the tower for their extraordinary courage and selfless devotion to duty, but concluded that the absence of an operational evacuation plan was a “major omission” in the LFB’s preparation for a fire at a building such as Grenfell Tower.

The report argued in length whether the “stay put” policy – whereby tower block residents were advised to stay inside their flats, to compartmentalise the fire – could have been reviewed by the brigade earlier in the night, so that more lives could be saved. This is undoubtedly one of the most emotive and controversial issues brought up by the report.

The report also called for a legal requirement on owners and managers of every high rise residential building to draw up evacuation plans and need for contingency planning, including speakers and siren systems, to alert residents to understand the evacuation drill when needed. This may prove more difficult to implement, especially in tower blocks with single staircases. Fears for the safety of elderly people and young children in such scenarios may require the government to bring in new laws to specify planning requirements for the number of stairs and lifts.

3. Improve the response, training and communication within the fire service.

The report was critical about the response of LFB, both on the ground and in the control room where 999 calls were handled – especially regarding how information from callers was processed and shared with ground commanders. The inquiry found that senior control room staff lacked the training to manage a large-scale incident, while operational commanders lacked the training to recognise the need for an evacuation – or organise one.

The report concluded with recommendations to improve call handling and staff training, and develop better communication channels between staff on the ground and and in the control room to facilitate direct communication. It also recommended providing an integrated system of recording fire safety guidance information.

4. Strengthening cooperation between police, fire and ambulance services.

The report also identified lack of coordination between the three emergency services (the LFB, police and ambulance), particularly in the “area of communication between control rooms” and in relation to the “advice to be given to callers” trapped in the tower.

Their failure to share declarations of a major incident – which calls for extra levels of command, control and coordination between emergency services – went against protocols and hampered a joint response between police, fire and ambulance services.

What lies ahead

The report identified massive communication and command challenges for the LFB – and makes a compelling case for organisational learning across the emergency services. My own research has also identified governance challenges and a lack of coordination between emergency services – as did the Kerslake Report on the Manchester Arena tragedy of May 2017. So clearly, these are persistent problems.


Read more: How to reboot Britain’s fractured emergency services


Giving staff proper training, re-assessing the way decisions are made and undertaking rigorous risk assessments – as recommended by the inquiry – will go a long way to reassure the public about fire safety in high rise buildings, and the conduct of emergency services. But it will require additional investments in the services, which are already grappling with spending cuts.

Fire services alone have witnessed a 12% spending reduction in real terms between 2010 and 2015.
Doing “more with less” is also proving difficult for ambulance services. And central government funding to police and crime commissioners has been reduced by £2.3 billion (25%) in real-terms between 2010-11 and 2015-16.

Phase one of the report has been revealing, but the public will be in a better position to exercise judgement after phase two of the inquiry has run its course, and identified the aspects of the “design, construction and management of the building that were primarily responsible for the disaster”.

Paresh Wankhade, Professor of Leadership and Management, Edge Hill University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Winter pressures and the NHS Ambulance Services: ‘Doing more with less’ is not an option

ambulances queuing outside A&E at a North West hospital

Paresh Wankhade, Professor of Leadership and Management and Emergency Services Management Expert discusses the issues the Ambulance Service faces as winter approaches in his latest Comment blog:

With each passing year, the winter crisis puts a massive strain on the NHS ambulance resources with huge bottlenecks in the transfer of patients into the hospital Accident and Emergency (A&E) wards. In 2017, media carried several reports which highlighted delays on the part of ambulance crews arriving at the scene, including deaths of the patient waiting for an ambulance. Some of these arguments have been well rehearsed and have also prompted emotional debates and the cries of “52 weeks of the year crisis” in the Parliament.  I have highlighted four issues which in my view are the key flash points for ambulance services to deal with such recurrent crisis.

Address the funding-demand gap

The sustainability of an underfunded and overstretched ambulance services is though well recognised, but remains unresolved. The National Audit Office reported that between 2009-10 and 2015-16, the number of ambulance calls and NHS 111 transfers increased from 7.9 million to 10.7 million (average year-on-year increase of 5.2 per cent), and income for NHS ambulance trusts’ urgent and emergency care activity increased by 16 per cent from £1.53bn to £1.78bn between 2011-12 and 2015-16, but ambulance activity over this period (NHS ambulance calls and NHS 111 transfers) rose by a massive 30 per cent. This is accompanied by significant shifts in the demand with only 10 per cent of 999 callers having a life threatening emergency despite the average annual increase of five to six per cent in ambulance demand.  Doing even ‘same with less’ is proving difficult for ambulance trusts, something I have argued in my recent piece.

 

Move away from response time targets

Response time targets have been historically used to measure ambulance performance. Since July 2017, performance of NHS ambulance trusts is being benchmarked against four new national standards, based upon patient’s condition, now enshrined in the NHS Constitution.  However, during May-September 2018, ambulance services in England failed to meet  all the standards. A recent Parliamentary Report concluded that ‘ambulance trusts have organised themselves to meet response-time targets, at the expense of providing the most appropriate response for patients’ (p.5).  Another view that ‘commissioners, regulators and providers still place too much focus on meeting response times” reported in the National Audit Report (p.8) is deeply worrying.

Our research points to similar conclusions. We have systematically documented a range of unintended consequences  of response time targets used by the ambulance services.  We have also explored the relationship between cultures, performance measures, and organisational change to understand how organisational culture is perpetuated and found the targets to be a significant factor impeding the process of change. Ambulance services have embarked on the drive for ‘professionalisation’ but our latest research suggests that as ambulance work continues to intensify, ‘issues around dignity, staff retention and the meaning of work are becoming ever more challenging’.

 

Introduce fines/penalty for hospital delays

Ambulance handover delays to hospital A&E departments can have serious implications for patient safety and reduce available ambulance resources. The 30 minute cycle (handover and readiness for next call) is proving difficult to resolve. NAO  figures suggest that in 2015-16, only 58 per cent of hospital transfers met the 15-minute expectation in 58 per cent of cases as against 80 per cent in 2010-11, and only 65 per cent of ambulance crews were then ready for another call within 15 minutes. There are inconsistencies on the part of commissioners to penalise hospitals that do not adhere to the guidance of 15-minute transfers in absence of a fining regime. A quality indicator for measuring hospital performance in meeting the transfer-time target has not yet materialised, notwithstanding the recommendations of the Committee of Public Accounts.

Improve efficiency and productivity

The Carter Efficiency Review, published last month, highlighted concerns about huge variations in the delivery of ambulance services. It suggested potential savings of £300m a year by cutting unnecessary ambulance transfers, along with further £200m through use of more efficient models of operations and procurement.  But the review also raised fundamental questions over the need for significant investment in the ambulance sector. The shortage and retention  of paramedic staff coupled with high sickness absence rates continue to be a problem, an issue highlighted in the draft NHS Workforce Strategy. However, the review raises the clear need for investment since one of the recommendations to reduce high conveyance rates is likely to have cost implications. This will also require high quality staff engagement.

 

Conclusion

There are no easy fixes and addressing the winter pressures will necessitate strong and visionary leadership by ambulance chiefs and cooperation from other health care partners, in a political climate dominated by Brexit. A ‘whole systems’ approach is crucial to deal with this crisis. The Dalton Review called for successful leaders to act as a ‘systems architect’ to use their entrepreneur skills to explore innovative organisational models, as set out under the NHS Five Year Forward View. The Carter Review necessitates ambulance leaders to make right business and spending decisions which will impact the NHS. Devising an effective public education campaign to minimise misuse of ambulance resources and managing public expectation, will be a good starting point.