Little shocks Martin Griffiths, lead trauma surgeon at the Royal London Hospital, but he recently surveyed the scene on ward 12D, the UK's first dedicated major trauma unit, and saw the resuscitation bays filled with wounded children. Half a dozen boys, aged between 12 and 16, had been rushed in from multiple incidents. All of them had knife injuries. It wasn't even 6pm.
"It's chastening," he says, "when your bays are full of adolescents who have been stabbed, and it's daytime on a weekday. They're being injured just after school closes."
Griffiths, 53, couldn't pause for long. Whenever a patient is brought to his ward with a knife wound – on average, twice a day – there is a race against the clock to keep them alive.
He is recalling the scene from his 12th-floor office, overlooking the span of north London. Rolling back and forth on a wheely chair, dressed in brown suit and spotty socks, he explains his plans to fix the capital's knife crime problem as the NHS's first clinical director for violence reduction. A role he was appointed to in June, it could hardly feel more pressing after another week of bloodshed, with three stabbing deaths in London, and another in Newcastle.
"Every person who dies on the end of a blade is a tragedy," says Griffiths. "We all have a role to play in reducing violence; be it a podiatrist, pharmacist, or paediatrician." His role complements the Government's confirmation on Monday that 18 local areas, from Northumbria to Hampshire, will receive a total of £35 million ($66m) in funding to set up new violence reduction units, modelled on a programme in Glasgow that halved its murder rate from 2005 to 2017.
Drastic intervention is needed: knife crime in England and Wales has hit a record high, rising 8 per cent to 43,516 offences, between April 2018 and March 2019. Outside the capital, the areas with the highest rates were Greater Manchester, the West Midlands and West Yorkshire.
On the front line, Griffiths has watched the number of Royal London patients treated for knife and gun wounds rise 20 per cent, year on year since 2012. His ex-military colleagues have compared the ward to Camp Bastion, a British Army base in Afghanistan.
"We routinely see people with more than half a dozen stab wounds," he says. "We're hypothesising that it involves multiple assailants rather than individuals – so we're moving towards collective violence." His patients are also getting younger; they have an average age of 16, but a quarter are even younger. Recently, he treated a five-year-old who had been shot.
Youth violence should be treated as a public health issue, he believes. "If 600 kids aged 18 and under were being hospitalised every year as a result of their mobile phones exploding," he has argued, previously, "there would be a huge outcry."
There was outcry of a different kind at yet another government initiative, last week: anti-violence messages printed on fried chicken packaging, which have been criticised by campaigners and opposition MPs for feeding racist stereotypes.
Griffiths won't be drawn on the subjects of drugs, gangs or stop and search. "I'm a healthcare worker, I'm not a politician or law enforcement expert," he says. "If you want to have your chest opened, I'm your man. But if you want someone to tell you about crime figures, I'm absolutely not."
He has, however, transformed trauma care at the Royal London since 2015, when he started inviting caseworkers from St Giles Trust, a charity that supports disadvantaged people, onto his ward to replicate the 'Wraparound Project' at San Francisco General Hospital, where he worked on a training fellowship.
The programme prevents future injuries and imprisonment by connecting patients with caseworkers who hail from similar backgrounds, some of whom have been in prison themselves, and are able to speak frankly about their prospects.
"We have children stabbing children and being murdered – it has become more frenzied," says Roisin Kerville, a caseworker for St Giles Trust who works closely with Griffiths."We meet young people at their bedside, [after] they have faced their own mortality. We put the question to them, 'What do you want to do now?' It lets them know they have choices... and that they're not alone."
One of the things that always struck Griffiths was the number of patients who recognised him, when they returned with new injuries. That figure has now plummeted from 45 per cent to one per cent, while the number coming back for follow-up appointments has rocketed.
"We've seen people on the fringes of gang activity, who have sustained significant injuries, come back and volunteer with our staff," says Griffiths, who wants to extend the programme to other London hospitals. St Giles Trust is already working in Coventry and Wolverhampton emergency departments.
This, though, is really the final stage in Griffiths' plan. "What we do here in the hospital, saving lives, is great," he says. "But the horse has bolted, been caught and made into glue by the time we've got to them. We really need to get back to looking at children – and I do mean children – before they're entering transition at year seven."
In his spare time, he visits schools and courthouses to share his own story with youngsters. Growing up in a Jamaican household on a council estate in Deptford, Lewisham – his mother, a healthcare assistant, also cleaned part-time and his father was a welder – he saw peers drawn to crime not through delusions of grandeur, he says, but "poverty, threat, and a lack of options".
It was his primary teacher at Myatt Garden School, Basil Morgan, who showed him another way. "This was the Seventies and he was an Afro-Caribbean male with a big 'fro and an English accent," Griffiths recalls. "He was in a position of authority in a school and it blew my mind."
Decades later, it is this memory that took Griffiths back to Myatt Garden to talk to pupils. "It's all very well reading about Anthony Joshua or Lewis Hamilton," he says, "but to actually meet somebody from your school who's gone on to success, someone from your environment and background who maintained their integrity and you can be proud of, is incredible."
When we meet, Griffiths has spent the morning speaking to teens at Goffs Churchgate Academy, Hertfordshire, about the dangers of carrying knives. The gruesome pictures he showed of bloodied patients and open chest wounds reduced pupils to tears.
"My talks have images designed to shock, of disfiguring wounds, open chests, and things that concern young people, such as wheelchairs and colostomy bags," he says. "Some brazen it out, but most are disturbed by the images." A question that often crops up is whether there's a safe place to stab someone. "In your dreams," he quips.
Jim Clune, former Met Police officer and now a director of learning at the school, says, "We don't have a gang problem here, but we're trying to be ahead of the game." He previously worked with Griffiths on a gang 'call-in' at Wood Green Crown Court, where young people were confronted with the horrors of youth violence by police, surgeons and parents of murder victims. "It resulted in a 26 per cent drop in serious youth violence in that area, when it was going up by 14 per cent elsewhere," says Griffiths.
The Home Affairs Committee last month called the Government's violence reduction strategy "completely inadequate" and said schools in areas with risk of serious youth violence should be appointed a dedicated police officer.
Gregory Logan, headteacher at Daubeney Primary School, Hackney, has been "desperately" trying to get police to come to his school alongside people like Griffiths and rapper Akala. "I want them to be part of our community when things are going well, so they're seen as public servants and not the enemy," says Logan. "Come to our fair, or a five-a-side football tournament." Engaging in this way will show youngsters and parents there are other paths, he says; "everyone who is appalled by the statistics should engage with Griffiths".
Although his ward's mortality rates are "vanishingly low", every death is painful. A few months ago, Griffiths recalls standing over the body of a young boy who had been stabbed to death, next to his father, who broke down and sobbed, "What am I going to do without my son?"
"I didn't have a word for it…," Griffiths says, fixing his gaze on me as that father did with him. "When you meet parents distraught at the loss of their child in a first world city like London, on a weekday, you ask yourself, 'Can we do better as a society?"
He explains how each death ripples across a community. "It will crush every person who knew them," he says. "Their family, their siblings, their friends, their neighbours, the community they grew up in, people they used to work with, play sport with. If I can prevent one death, one family from having their lives wrecked by that incident, then I've done good work."