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Alan started his fire and safety career with Warwick County Fire Service in 1963 and served as both an Operational and Fire Safety Inspecting Officer. In 1976 he transferred to the West Midlands Fire Service until 1978 when he moved to the NHS as the District Fire Safety Officer for West Birmingham Health Authority where he was also the West Midlands Regional Health Authority Fire Advisor. During his NHS career he worked and studied for six months in the USA looking at different approaches to fire safety. He was also responsible for developing a computerized hospital fire evacuation program that was used in many major hospitals. In 1994 Alan moved to HSBC as its Senior Fire and Safety Officer responsible for the 80 countries in which the bank had a presence. During his career with HSBC he established a global approach to fire safety, organized many international fire and safety conferences, and developed a standardized method of protecting computer areas from fire. In 2005 he set up his own Fire and Safety Consultancy. During his career he has published a number of books on fire safety and made many specialist technical videos on subjects such as hospital evacuation, fire protection of electronic data protection areas, fire doors, and mail room safety. He has been awarded a Brooking NHS Travel Fellowship, Rospa Safety Professional of the Year (twice), FPA Premier Fire Safety Award, and The Prime Minister's Quality Initiative. He also contributes to many fire and safety journals including Fire, IOSH, Fire Surveyor, and Health and Safety Journal. He is a fully qualified Fire Service Inspecting Officer, member of the International Institute of Risk and Safety Managers (MIIRSM), Tech IOSH, and Qualified Fire Investigator. Alan has advised many large companies including the National Trust, Hospital Corporation of America (HCA), Kings College, Cambridge, Briton Hardware, BUPA, British Antarctic Survey Expedition, Chubb, Central Television, BBC, Radisson SAS, and the Falkland Islands Police.
February 11, 2016

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The Clandon Park Fire: Questions from a National Trust Member

Having read the Report of Fire prepared by Surrey Fire and Rescue Service I feel that a number of questions relating to the incident require clarification.

Whilst the report is entitled Report of Fire it does not outline in any great detail very much information about the fire safety history of the building and tends to concentrate more on the cause. However, with any serious fire like this what happened before, during and after the fire tells us more about what really happened and why?

Two months ago before the publication of this report I made these comments about the fire:

“It is so sad to see buildings like this devastated by fire when we have so much technology and expertise available today to help us prevent such occurrences.

“As can be seen by the structure that remains, many of the internal and external walls remain intact and so the fire appears to have spread both vertically and horizontally at a very rapid pace – so why did this happen? Was it because of poor fire separation or inadequate fire detection systems, perhaps the staff fire procedures were not good enough or could it have been a poor fire risk assessment or a combination of all of these factors?

“What of course we do know is that if fires start in these old buildings the results can be devastating and sprinklers would certainly have helped but there is a reluctance to install these types of systems in buildings like this due to cost and disruption. These days there have been tremendous advances in fire detection and warning technology and there are systems that can detect very small shouldering fires and alert the occupiers and fire service in minutes. In addition to this there are materials and methods available today that can improve the fire resistance of doors and structures without detracting from the overall appearance – so were these installed here or were they too costly as well?”

[mk_image src=”//www.ifsecglobal.com/wp-content/uploads/2016/02/Tweet-Clandon-Park-2.jpg” image_width=”2600″ image_height=”5000″ crop=”false” lightbox=”false” frame_style=”simple” target=”_self” desc=”Tweet shortly after the fire broke” caption_location=”outside-image” align=”center” margin_bottom=”10″]

Unfortunately, today we rely on what is called a Fire Risk Assessment (FRA) which is usually a piece of paper completed by a competent person that looks at the building and the various fire safety features and factors and decides if the building is safe – as there were no reported injuries it could be said that the FRA did what was intended but what about the loss to our nation – well that is for the National Trust to answer.”

The National Trust replied and indicated that they were waiting for the fire service report and I replied, “whilst the fire service report is important I would have thought that your report was more pertinent as it should give a more comprehensive picture of what happened prior to the fire”.

We now have the fire service report but I feel that we now need to see the Trust’s report about the fire in the hope that it will answer these concerns.

Areas of Concern

With a report like this on such a serious fire I would have expected a plan and timeline to be available in the report that would enable the reader to establish such things as:

  • Where horizontal and vertical fire separation was provided?
  • Where both fixed and portable fire-fighting equipment was installed?
  • Where automatic fire detection was positioned?
  • What other active and passive fire precautions were installed and did they work?

In addition I would have expected it to include:

  • What fire safety maintenance had been carried out?
  • Which fire escape routes were used?
  • What fire training had staff/volunteers received?
  • What inspections had taken place both from the NT, insurers, risk assessors and the fire service?
  • What was the Fire Safety Policy and associated action plans?

Without a layout plan it is very difficult to follow the pattern of events with any degree of accuracy:

If you take for example the statement contained in 4.3 “As part of the investigation the building’s fire alarm panel information was accessed and the timing and location of activated smoke detectors show that prior to the arrival of the fire service smoke had travelled to the roof space.” If you examine the timings 
you will note that the 999 call was made at 16.08 and the fire service arrived at 16.17. This statement, if the timings are correct, tells us that within 9 minutes the smoke had travelled from the basement to the roof space.  So, how did this happen:

  • Did the person who discovered the fire make any attempt to tackle the fire – remember it is stated “He went to the fuse board to investigate the loss of power and on opening the cupboard discovered the fire inside” – there is no reference to smoke or fire at this time, only loss of power so it is reasonable to assume that the fire was not too large at this point and could have been tackled with a fire extinguisher by a trained person.
  • If we now look at the smoke and fire spread and the speed at which this happened – did the person that discovered the fire shut the door on the fire, was it a fire door, how did the smoke and fire get into the lift shaft and was there any fire separation to the shaft? Were other fire doors closed?
  • If we now consider Part 7.1 c) that states, “It is believed the fire was able to spread in to the room above the distribution board cupboard due to a lack of fire compartmentation above the board.

An electrical contractor’s report in 2010 noted a lack of fire stop/barrier to the ceiling recesses of the distribution board cupboard.

This report did not recommend any remedial work regarding this issue.”

[mk_image src=”//www.ifsecglobal.com/wp-content/uploads/2016/02/Clandon_Park_after_the_fire.jpg” image_width=”800″ image_height=”350″ crop=”true” lightbox=”false” frame_style=”simple” target=”_self” desc=”Shot of Clandon Park after the fire of April 2015 showing the remaining shell and the beginning of structural conservation work. Author: BristolIcarus” caption_location=”outside-image” align=”left” margin_bottom=”10″]

Whilst the electrical contractor’s report did not recommend any remedial work who in the NT decided not to do anything about it because clearly the contractor was concerned enough to raise the issue and this may have been the reason the fire was able to spread so quickly – so this may have been a very costly omission for a small amount of work.

  • Looking at Section 8.2 the approximate time of the fire starting is given as 16.00 hours – so it can be assumed from this figure that apart from the power failure between 16.00 and 16.08 when the fire was discovered not a lot happened as there are no reports of fire or smoke until 16.08 but within the next 9 minutes smoke travelled to the roof space from the basement.
  • If this fire was because of an electrical fault it would have been beneficial to see that the NT had fully complied with the current electrical regulations and that there were no outstanding requirements or recommendations that had not been complied with.

I would have thought that in a building like this thermal imaging technology would have been used as this has the ability to detect problems like this.

  • One media report states The Trust insists all safety measures had been installed, although the absence of sprinklers will surely have to be explained when the fire report is finally made public. Heritage experts will also be scrutinising the Trust’s fire risk assessment to see if the house’s grade I-listed status had compromised safety recommendations. It would also have been helpful to see the Fire Risk assessment for this building.
  • According to another media report the NT also stated when asked if extra defences had been installed in other National Trust properties since the Clandon Park disaster,“All of our properties have regular inspections from their local fire service and from insurers, so our buildings already have the right sort of fire precautions built in, compartmentation or others. But the thing we need to check is that there isn’t more that we can do and that the compartmentation we have is absolutely fire-proof.”
  • One important question that needs answering in more detail is How a fire that allegedly started in a cupboard and was discovered by a member of staff, was able to develop at such a rate that 95% of the building was damaged?
  • It is also clear from reports in the media that the fire service also had its problems and these are some of the concerns that were highlighted in the media:
  • Whilst the first appliance arrived in 8 minutes the second appliance took 21 minutes missing its target by 6 minutes. In practice this meant that there was only one 4-man crew available to tackle the fire for 13 minutes at the most important stage of the fire.
  • Comments from firefighters, who toiled unsuccessfully to tackle the fire, paint a picture of frustration and potentially missed opportunities.
  • An internal review by Surrey Fire and Rescue Service (SF&RS) following the fire reveals the service took on board many of its frontline firefighters’ concerns about how the operation was handled.

The time it took to summon a crucial pumping system, as well as “unclear” allocation of roles at the scene, are just some of the “areas of learning” identified in a Command Review Corrective Action Plan.

The Cause of the Fire

Whilst the cause of the fire appears to be a strong possibility I have now discussed this with an electrical engineer colleague and we share the following concerns:

  • It would be interesting to know when the last inspection of this distribution board was carried out and exactly what was done during the inspection.
  • If this distribution board was delivered from the manufacturer with this fault – has the manufacturer confirmed this point and if so, I believe that this information should be made available for the benefit of other interested persons.
  • With an installation of this age and of this nature why didn’t the NT use “thermal imaging” to check for these possible problems?
  • Was any discolouring of cables observed prior to the fire?

I did ask Eaton the company that acquired MEM about the incident and they replied as follows “Unfortunately, at no point during the creation of this report was Eaton contacted by or asked to be involved by the investigators. As you can appreciate, because we have not been involved in any part of this investigation and are not privy to any of the physical or photographic evidence relating to the creation of the report, we are unable to comment or speculate on the likely cause of the fire as well as any assumptions related to the supply, installation, commissioning and ongoing maintenance of the electrical system in Clandon Park”.

In my experience I believe that where an item of equipment is involved and suspected of causing a fire the manufacturer should always be consulted, as they are likely to be an important link in the investigation. Eaton also went on to state “It is unfortunate that no-one asked us to be involved in the investigation as without access to any of the physical evidence or very precise technical questions, it is impossible to comment when what is presented is the investigator’s opinion and assumption.”

Conclusions

I don’t believe that this report gives us a great deal of information about the wider aspects of the incident and it certainly does not give me any confidence that it reflects exactly what happened. It is important that we learn from incidents like this and I think that as a National Trust member for many years and from someone who has given their time freely to this organization we deserve to see the full picture.

I have also stated in previous investigations that I don’t believe that the authority that has been responsible for giving both good will and statutory advice should be the one to produce such a report, as there is a “vested interest” in the subject, which in my opinion is not likely to produce an open and honest conclusion.

I think that the NT has a duty to make their internal report public so that we are able to establish a clearer picture of all the events that occurred prior to this devastating fire.

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Alan Cox
Alan Cox
February 11, 2016 3:01 pm

If anyone wants to read the report it can be found here https://www.nationaltrust.org.uk/news/clandon-fire-report-published

Neil Ashdown
Neil Ashdown
February 13, 2016 9:39 am

Most building owners/managers seem to have little appetite to make even basic improvements in fire separation precautions. This is disappointing given the news coverage given to fire events and the huge damage caused to property not to mention risk to life.

Is this because fire protection technology isn’t understood, is the issue one of cost vs risk or is it because since the Fire Safety Order came in that the local fire and rescue services are not as closely engaged as before?

Alan Cox
Alan Cox
February 13, 2016 4:56 pm

Neil, Thanks for your comments which are both interesting and pertinent and perhaps I can give you my thoughts on the matter. I think that you are right in your first statement that “Most building owners/managers seem to have very little appetite to make even basic improvements in fire separation precautions” and this is clearly down to the fact that it does not appear to be enforced to the same level that it previously was and as you further state “the fire protection technology isn’t understood. I would go a stage further and add that I don’t think the concept… Read more »

richard woodward
February 18, 2016 5:55 pm

Hello Alan,  Thanks for the notification of this report.  I too am a member of the NT and care passionately about protecting our heritage. Your article is certainly comprehensive and I will set aside some time to have a read through the report. The thing that sprang to my mind immediately was that a fire risk assessment to meet the legal requirements of the FSO 2005 will only assess the life safety risks to relevant people. Although the NT may have had a valid assessment in place I think a detailed property protection fire risk assessment should be standard practice for… Read more »

Alan Cox
Alan Cox
February 18, 2016 7:57 pm

Hi Richard, Thanks for your comments and like you I am also passionate about protecting our heritage, as I am sure you have noticed. It is a great pity that no one from the NT or the FRS have responded because clearly they have the information that we need and I have now written formally to the Director General requesting a reply. As you state the Fire Risk Assessment (FRA) will normally only address the life safety issues but I would have expected that in a building like this for the life safety issues to go hand in hand with… Read more »

J0N8than
J0N8than
February 19, 2016 11:14 am

The Trouble with a lot of old buildings and passive fire protection, it is only put in areas of escape routes and not all over the buildings? So it is primarily for the safety of lives and not the safe keeping of the building! We do need someway of brining in a law that states these Historical Buildings need to be fire protected throughout so that the whole building will be safe and left almost intact when a fire starts? protected so that when a fire starts it is limited to its spread by good COMPARTMENTATION. This means that the whole… Read more »

Alan Cox
Alan Cox
February 19, 2016 3:23 pm

Hello Paula, Thanks for your comments, which are most interesting, and like you in many buildings that I inspect I provide both life safety and building protection advice – especially with buildings like this. Unfortunately, the FRS do not usually go down the same route and I remember a few years ago speaking to a group of FRS Inspecting Officers and telling them that I was always trained to give good will advice along with statutory advice if I observed something that – whilst not required by law could affect the building or the occupants – and so I have… Read more »

David Cole1365
February 24, 2016 9:48 am

Alan. I worked on the steering committee to redraft CIRIA736 which was a result of the pollution caused by the Buncefield oil terminal fire in 2005. The impact of a fire is huge and events like Buncefield could have resulted in many deaths if the timing had been different. The polluted ground water from the fire and subsequent Fire fighting response will impact us for many years. It is worth reading as I’m sure you have the lessons learned part of CIRIA736. The FRA is only as good as the required action, too many businesses choose to cut the cost… Read more »

Alan Cox
Alan Cox
February 24, 2016 4:40 pm

David, Thank you for raising this issue that as you say is often overlooked when carrying out a Fire Risk Assessment (FRA) It is an interesting issue that you raise as when I trained in the fire service the use of excess water when fighting a fire was regarded as poor firemanship but I am not sure what the teachings are now. Ideally, you should only have put on enough water to extinguish the fire which then turned into steam but of course in practice this was very difficult to achieve. I was recently discussing this issue with one FRS… Read more »

David Cole1365
February 25, 2016 10:58 am

Hi Alan. I would be happy to. It was during the CIRIA736 work that I introduced spill mapping so that I could solve an issue like Buncefield. We take flood technology and work out what happen when we have critical failure. Its a really interesting subject as I haven’t found a site yet that’s EMS works. I actually invented my first product envirovalve to contain drainage runoff, I think the EA and FRS still use this product today, came from my garden shed!! Clearly protecting life is the No1 priority but the impact of a major pollution release could impact 1000s of… Read more »

rjd459
rjd459
February 26, 2016 11:33 am

Alan,  The obvious veiled disappointment in the report from the FRS with such lack of specific detail and lines of investigation not fully examined are apparent. With changes to FRS over the last 10 years with the loss of highly experienced personnel has often seen a change of the remaining skill sets within the FRS as a whole, with fire reports often being undertaken with less detail than would of been found in the past. The hidden spread of fire throughout a heritage premises has always been of concern to FRS and subsequent salvage operations expected on the outbreak of… Read more »

Alan Cox
Alan Cox
February 26, 2016 4:20 pm

Richard, Thanks for your comments – we clearly have similar thoughts on the subject. As you say the report is so disappointing with lack of “specific detail and lines of investigation not fully examined or apparent” and I often wonder if this is intentional or simply the way that these reports are going? When you look at this report there are obviously important things missing that makes it virtually useless for anyone trying to establish what really happened and in my view the report raises more questions than it answers. If you look at the attendance times and query why… Read more »

Alan Cox
Alan Cox
March 1, 2016 10:49 am

I have now received a reply from the NT in response to my second enquiry and they have declined to answer the following questions that I sent to them: I have found some plans on the internet and I wonder if you could let me know where the fire compartments were situated together with the lift shaft and electrical cupboard? In respect of the fire spread the SEFIG Report states “It is believed that the rapid fire spread observed at this incident occurred when the fire quickly reached the lift shaft allowing the smoke and fire to rapidly spread to… Read more »

Alan Cox
Alan Cox
March 15, 2016 5:32 pm

As the National Trust declined to answer some of my questions I served Freedom of Information Requests on both London and Surrey FRS and I have now heard from London FRS who confirm that they have not issued any notices recommending that any action be taken by NT

Tony Graneek
Tony Graneek
April 15, 2019 6:47 pm

Would it have been more useful to locate the electrical distribution cupboard in the roof space with the cable feeding it thoroughly encased in a fire resistant duct? That would prevent fire travelling up through a building, This is not the first building to be damaged in this manner.