Lincolnshire Fire and Rescue Service: Causes of concern revisit letter

Published on: 22 April 2022

Letter information

Roy Wilsher OBE QSFM
Her Majesty’s Inspector of Fire & Rescue Services

Mark Baxter, Chief Fire Officer
Lincolnshire Fire and Rescue Service

Councillor Lindsey Ann Cawrey
Chair of Fire Authority

Sent on:
22 April 2022


We inspected Lincolnshire Fire and Rescue Service during April and May 2021. During the inspection, we identified two causes of concern. In July 2021, we issued both of these causes of concern and made the following two recommendations:

The service hasn’t taken enough action since the last inspection to appropriately resource its protection function.

By 30 September 2021, the service should:

  • produce a clear plan for how it will make sure all premises it has identified as high risk are audited in line with the timeframe set out in its risk-based inspection policy;
  • review its administration of the protection function to make sure it can record and review all work clearly and consistently; and
  • make sure it has an effective quality assurance process in place so the service can assure itself that staff carry out audits to an appropriate standard.

The service hasn’t done enough since the last inspection to improve equality, diversity and inclusion (EDI) in the service.

By 30 September 2021, the service should:

  • give greater priority to how it increases awareness of EDI throughout the organisation;
  • make sure that all staff get appropriate EDI training;
  • improve how it works with its staff and give feedback about EDI issues;
  • improve the understanding and use of equality impact assessments in all aspects of its work, and consider if its policies and procedures are inclusive and support people with protected characteristics; and
  • put in place a clear plan with timescales for improving its management of risk information.

2. On 16 September 2021 you submitted an action plan setting out how you would address the causes of concern and our recommendations. We reviewed the action plan and received further updates from you on 11 November 2021. In our letter of 14 December 2021, we acknowledged the progress the service was making.

3. Between 28 February and 2 March 2022, we carried out a revisit to further review progress. During the revisit we interviewed staff who were involved in developing the action plan, including you as chief fire officer (CFO). We also interviewed managers and staff with responsibility for protection and EDI together with colleagues from their teams. On 7 March 2022 we concluded the revisit process by giving you our initial findings. This letter provides an update in that respect.


4. We saw that the service had continued to maintain the governance arrangements it had in place to monitor progress against its action plan. These arrangements were described in our letter of 14 December 2021.

5. In addition to the action plan, the CFO sends weekly written updates to the portfolio holder for fire (Lincolnshire County Council) and has monthly meetings with the fire authority to update it on the causes of concern.

Action plan

6. The service has an action plan covering the causes of concern identified in our letter to the service of 5 July 2021. We reviewed the plan and commented on progress in our letter to the service of 14 December 2021. You gave us an updated action plan for the revisit.

7. The action plan outlines a monthly update of progress. We can clearly see how the service is continuously monitoring progress against this plan.

Progress against causes of concern

Protection – risk-based inspection programme (RBIP)

8. The service has made good progress in response to this cause of concern. When we inspected the service in April 2021, we found that only 95 out of over 400 premises identified as being high risk had been audited in accordance with its RBIP. At the time of our revisit, the service had significantly reduced this backlog. There were only 40 audits outstanding.

9. The service has assured us that all the outstanding audits will be completed by the end of March 2022. We are satisfied that the service has the capacity to do this.

10. To reduce the backlog, the service has had to reprioritise its workload within the protection team. This is because it is under-resourced. The team has often been operating with 12 members of staff, instead of its budgeted headcount of 16 staff. Prioritising the RBIP has meant that the service has been unable to carry out some other protection activities, such as auditing medium-risk and low-risk premises, and issuing petroleum certificates.

11. We acknowledge that considerable effort has gone into reducing the backlog of audits. But at the time of our revisit the service didn’t have a clear plan about how to continue with its RBIP beyond March 2022. That said, the service is in the process of developing a four-year plan, which it is currently consulting on. As part of the plan, it has completed a reassessment of all of its high-risk premises. It has been developed using guidance from the National Fire Chiefs Council (NFCC).

12. To carry out the proposed four-year plan, the service needs 17 members of staff in its protection team. The service recognises it could take up to 18 months to recruit and train the additional staff it needs, so it is too early to say if the service has a clear and achievable long-term plan for the future.

13. The service has improved its administrative function in relation to protection. During our revisit we reviewed five protection files. We found that the service had introduced a file tagging system so that records could be searched by category and easily located. Instructions have been issued to all staff to make sure that the records are completed in a consistent way and to an appropriate standard. We are satisfied that the service has taken appropriate action to address this recommendation.

14. The service still needs to put in place an effective quality assurance process. Presently, the service only has the capacity to quality assure a limited number of its audits. This is because some staff who would have completed the quality assurance have been carrying out high-risk audits instead. As a result, the service is only able to dip sample the records of staff who are less experienced in completing audits, rather than the entire team’s work.

Equality, diversity and inclusion

15. During our inspection in April 2021, we identified a lack of awareness and understanding of EDI. While swift action was needed, we recognise that fully resolving these problems takes time. We are pleased to see tangible progress in this area.

16. We found that the senior leadership team was clearly intent on making EDI a priority throughout the service. This is reflected in the leadership displayed by the CFO, who now chairs an EDI steering group. The service has established a wellbeing group, together with three task and finish groups. These groups concentrate on developing EDI training, equality impact assessments (EqIAs) and communications. Staff and volunteers throughout the organisation actively participate in these groups.

17. The service has also created some staff networks, such as a women’s network, an LGBTQ+ group and a carers support group. We noted that some of these networks had only recently been formed.

18. Staff spoke positively to us about the way in which the service was engaging with them about EDI. Some staff, who are now members of the EDI steering group, welcomed the opportunity to be able to feedback directly to the CFO as part of the new meeting structure. The senior leadership has also improved its communication with staff through station visits, video conferencing sessions, its weekly bulletin and video blogs.

19. The service has recently introduced a comprehensive six-month training programme for EDI. It has chosen to do its training face to face, to make it more interactive for staff. The service has also conducted a staff survey about EDI and intends to carry out another survey when the training has been completed. This will be used to inform maintenance training.

20. The service has improved its use and understanding of EqIAs. Since our inspection in April 2021, it has adopted the NFCC template for EqIAs and has completed one for all of its premises. The service now completes an EqIA for every policy that is due for renewal. Staff were able to give some good examples of where an EqIA had led to improvements, especially for those people with protected characteristics. One example was the removal of the bleep test from the recruitment process after the EqIA indicated that it may have disadvantaged some potential recruits. We are satisfied that the service has taken appropriate action to address this recommendation.

21. We were told that positive action awareness training had been included as part of the EDI training programme, and the recruitment team had been given bespoke training to improve its ability to recruit from under-represented sections of the community. The service now uses an analytical tool so that it can learn from past recruitment processes and focus its recruitment activity more effectively. We were pleased to see that the service had integrated positive action initiatives into its recruitment calendar.


22. The revisit team were pleased to see the significant steps the service had taken in response to the causes of concern we issued. The increased levels of oversight and monitoring the service now has in place to track progress reflect its determination and commitment to make the required improvements.

23. We recognise that the service has made good progress in terms of its protection function, specifically auditing its high-risk premises. But, as previously stated, when the service introduces its four-year plan, it should be doing things more efficiently. We aren’t yet clear whether the service will have the capacity and capability it will need to carry out its RBIP in the future.

24. The service has good plans in place to increase awareness of EDI throughout the organisation. Senior managers are working hard to integrate EDI and to involve staff in the process. We recognise that this will take time to achieve.

25. Despite the good progress being made, there is still more work to be done. The service has a comprehensive action plan, and it has governance arrangements in place for continued oversight. We acknowledge that the service now has an effective administrative function in place for protection and is using EqIAs more effectively.

26. We aren’t yet in a position to close off either of these causes of concern. We will continue to monitor progress through updates from the service and data returns for protection. We will carry out a revisit to the service in the autumn of this year. At that time, we will be specifically reviewing progress in respect of protection. We will inspect progress against EDI in the workplace when we next inspect the service in Round 3.

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Lincolnshire Fire and Rescue Service: Causes of concern revisit letter