David Oliver: Lessons for NHS staff from the Grenfell inquiry

I recently saw a play entitled Value Engineering: Scenes from the Grenfell Inquiry.12 The theatre was within sight of the Grenfell Tower, a 24 storey, 1970s residential tower block in west London, where 72 people lost their lives in 2017 in a completely avoidable blaze that destroyed the building.3

The dramatisation relied entirely on dialogue taken verbatim from transcripts of the public inquiry that followed. Key to the whole tragedy was the use of highly combustible cladding material of a kind that had already led to fatal fires in other tower blocks in London and overseas. The risk was compounded by a small gap left between the cladding and the building, leading to a “flue effect.”

We heard from a firefighter and a fire service call handler battling a situation they were not fully prepared or equipped for. We heard testimony on behalf of residents about their long expressed concerns regarding the building’s safety. We heard how these residents had been marginalised as poor or from ethnic minority groups in a generally wealthy borough. We heard about a letter from one resident written in 2014, which set out every foreseeable risk in some detail. Such concerns had been raised repeatedly by residents and ignored repeatedly by the housing association that owned and ran the building and by the local authority responsible for inspection and regulation.

Just as in the real, two stage Grenfell inquiry,4 chaired by a retired judge, Martin Moore-Bick, the play turned to evidence from architects, building contractors, and providers and fitters of cladding material. Transcribed dialogue spoken by the actors was interspersed with written communications by and between various agencies—all of which had expressed concerns about the safety and specification of the cladding and about fire safety within the building.

Yet every one of them, to some degree, assumed that other parties would take responsibility and carried on with the cladding plan. In some cases this was explicitly about winning contracts based on low costs or about keeping costs down. All of this makes the title “value engineering” sound rather ominous.

So, what does this have to do with the NHS? The NHS is also a safety critical industry involving many parties, where problems can have serious consequences for people relying on our services and for frontline staff. Ensuring that people are adequately staffed, trained, and equipped even for relatively rare incidents remains important. This includes learning from historical incidents.

When people using our services are raising the same concerns about safety repeatedly and in numbers, we need to listen and act. Staff may not have a moral responsibility or have to bear individual accountability for failings in infrastructure, capacity, workload, or staffing—but we do have a responsibility to draw attention to those concerns repeatedly, not to turn a blind eye, and to keep a paper trail for future reference. If we worry about our careers in doing so, the concerns are best raised by organised groups, with the backing of professional associations.

Bosses have a reciprocal obligation to heed those concerns, create a culture where no one is afraid to speak out, and act on them or explain their reasons for inaction.

Perhaps most of all, anyone who openly describes serious risks and failings in written communications, but then carries on regardless for the sake of an easier life, should remember that one day they, like the Grenfell witnesses, may find themselves having to defend the paper trail of their action, complacency, or inaction at an inquest, inquiry, court case, or regulatory action.

Let’s hope that this will focus people’s minds on doing the right thing.