'Decades of failure': Key findings from the Grenfell Inquiry's final report
ITV News Correspondent John Ray breaks down the key findings of the long-awaited report.
Words by Olivia Mustafa, producer and Maya Bowles, Westminster producerThe final report on the Grenfell Tower fire has revealed "decades of failure" by the government and other bodies in positions of responsibility.
The report is the second of a long-running inquiry into the fire in June 2017, which claimed the lives of 72 people.
Victims of the fire included men, women, and children, ranging in age from an unborn baby to an 84-year-old woman.
The fire initially broke out in a fourth floor flat in the early hours of June 14, 2017. A call was made to the London Fire Brigade just before 1am. Barely half an hour later, flames had reached the top floor of the 24-storey block.
The report provides damning criticism of the government, construction companies and regulators, and has offered a number of recommendations, including an independent construction body, a licensing scheme for contractors working on high-risk buildings and an inspection of the London Fire Brigade.
The report into phase one of the inquiry was published in 2019, and found the tower's cladding did not comply with building regulations and was the main reason why the fire spread so rapidly.
Reacting to the final report, the survivors and bereaved families from the tragedy said it was "a significant chapter in the journey to truth, justice and change - but justice has not been delivered."
"Whenever there's a clash between corporate interest and public safety, governments have done everything they can to avoid their responsibilities to keep people safe," they said.
Chair of the inquiry Sir Martin Moore-Bick said on Wednesday: "The simple truth is that the deaths that occurred were all avoidable, and those who lived in the tower were badly failed over a number of years, and in a number of different ways, by those who were responsible for the safety of the building and it's occupants."
Speaking in the House of Commons, the prime minister addressed the bereaved families and survivors directly, saying "I want to start with an apology on behalf of the British state".
"You've been let down so badly - before, during and in the aftermath of this tragedy", he said.
The Metropolitan Police are now able to consider whether criminal charges can be brought against those involved in the disaster. They say this process will take at least a year.
Here are the report's key findings - and what the inquiry has recommended.
The role of successive governments
The report found there were missed opportunities by multiple governments in the lead-up to the Grenfell Tower fire, dating back to the Knowsley Heights fire in Merseyside in 1991, where cladding played a role in the blaze's spread.
It also said governments failed to take heed of several warnings about cladding from 2001 through to 2017.
The government marked the materials used in the cladding on Grenfell as 'safe' based on something called the "Class 0" rating, despite knowing it wasn't an appropriate standard for judging its fire safety.
The Department of Communities and Local Government was poorly run, complacent and at times defensive when it came to fire safety, it added.
According to the report, the government took on a "deregulation agenda" after the Lakanal House fire in Camberwell, London in 2009, which killed six people.
The report named former Minister for Communities and Local Government Lord Eric Pickles, who is described as an "ardent supporter" of housing deregulation.
Lord Pickles said in a post on X he welcomed the findings of the report - "I particularly welcome the call for greater transparency and coordination within government," he wrote.
The report has now called for a government body to be responsible for fire safety and testing and regulating construction products. It comes after the report found previous arrangements for regulation in the construction industry were too fragmented.
The construction industry and its regulators
A number of companies in the construction industry, and those tasked with regulating products, have been held accountable by the report.
The Building Research Establishment (BRE), an organisation offering testing and certification of products, was found to have unprofessional conduct, and directly worked with companies to advise them how to meet testing criteria.
Companies who sold products were found showing "systematic dishonesty", deliberately manipulating testing processes and misleading the market. The BRE and Celotex, who manufactured the insulation boards used in Grenfell's refurbishment, were found to be complicit in this.
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Arconic, the company which supplied cladding panels believed to have fuelled the blaze, has been found to have continued selling products despite knowing of safety concerns, and at times concealing information.
Arconic rejected the conclusions of the report, saying "it did not conceal information from or mislead any certification body, customer, or the public".
The British Board of Agreement certifies the compliance of construction products. The report found its procedures were not independent and certificates were accepted without question.
Refurbishment of the building
When Grenfell was refurbished, a number of organisations, including the architect Studio E and refurbishment contractor Rydon, assumed they weren't responsible for assessing fire safety.
The report also found Kensington and Chelsea's Tenants Management Organisation (TMO) opted to reduce costs, which led to aluminium composite panels being chosen for cladding.
It also spoke of a "toxic" atmosphere of mistrust between the TMO and the residents.
Exova - which provided fire safety advice to the TMO - was found to have failed to produce a final version of the fire safety strategy.
Both the TMO and the Royal Borough of Kensington and Chelsea were found to have a "persistent indifference" to fire safety.
The TMO say they accept the organisation "contributed" to the tragedy, and are "deeply sorry".
The report has recommended the profession of fire engineers be recognised and protected, and advised the government to create more places on Master's courses in fire engineering.
It also recommended a licensing scheme should be put into place for contractors wanting to work on high-risk buildings - and that the definition of "high-risk" be reviewed and potentially expanded.
The London Fire Brigade
According to the report, the London Fire Brigade should have been aware of the shortcomings of cladding, particularly with regard to high rises after the Lakanal House fire in 2009.
It also highlighted a chronic lack of effective leadership and issues with training control room staff.
The report gave a number of recommendations for the London Fire Brigade, including that His Majesty's Inspectorate of Constabulary and Fire & Rescue Services inspect their control room.
It also recommended the National Fire Chiefs Council look into whether firefighters should be discouraged from using their own initiative, rather than official instructions, in similar situations.
Response to the disaster
The Royal Borough of Kensington and Chelsea was found to have a "muddled, slow, indecisive and piecemeal" response in the immediate aftermath of the incident.
The report said aspects of the council's response showed a lack of respect for "human decency", including a failure to do enough to accommodate those fasting during Ramadan.
The council lacked an effective displacement plan and its Chief Executive Nicholas Holgate did not take effective control of the situation, it continued.
As a result, the report recommends all local authorities have proper methods in place to deal with people displaced from similar disasters.
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