A love letter to invisible designers

Sarah Drummond
Service Design Advent Calendar
10 min readDec 22, 2021

A global pandemic was thrust into our news headlines in late 2019. In 2021, we’re at the end of another difficult year where the world continues to respond to extraordinary circumstances

I was asked to contribute to the Eclectic Service Design Advent Calendar and whilst I could write about tools or approaches I wanted to fly a flag for the invisible design that goes on often unrecognised or below the surface of explicit user experience design.

It’s been nearly two years since our world faced national lockdowns, social isolating, over stretched health services, businesses struggling to stay alive and the loss of human life more than we’ve had time to collectively grieve for.

In the UK, you couldn’t turn a corner without seeing a thank you NHS sign, lovingly hand painted by a family and stuck to their windows.

But I wanted to pay homage today and reflect on the invisible design work that happens at a time like this. We’ve witnessed one of the greatest coming together of professionals in operational, design, data and technology roles to put in place the infrastructure, products and services to enable us to get tested, book vaccinations, travel safely, and generally interact with health services in a chaotic environment.

I’d like to just take a moment to say thank you to all the people involved in the late night zoom calls challenging design decisions, the 20 hour work days shipping products for 67 million people and the weekend working to change content on Government, council and NHS websites when new plans were announced without notice. This happened across the NHS, across Government, in charities, in local authorities - you were all brilliant. Consider this my pot clanging and clapping you, thank you!

Good Design is often invisible

Find my NHS Number service

It’s easy to overlook this effort particularly in stark contrast to the visible reminders of the sheer exhausting conditions frontline workers faced, like damage to their skin from wearing PPE for 12+ hours, and believe me I’ve thanked them in every way I can by donating to various causes.

Good design is often invisible because it’s frictionless. I’ve found the user experience of meeting my needs, like booking a vaccine to be flawless. Simple to use, and made all the easier by the phenomenal find my NHS number service which has been a perennial problem for years. How many of us have been leafing through bits of paper in a stuffed ‘important docs’ drawer or going silent on the phone when asked for it.

Getting a vaccination and bringing it up on my NHS app as a covid passport was also a dream, thanks in large part to the invisible technical architecture to link up different settings like hospital hubs, vaccination centres, local vaccination services.

Add this to the long list of amazing work like building a testing service that works for everyone and making it easier for families to report a household test, or safely integrating a vulnerability assessment into data systems to identify people who might be at high risk of serious illness. All of this work is invisible to many of us, so I’d like to say a huge thank you again, it makes such a difference. Removing any barriers to people using and accessing services is key.

Services in a pandemic are operating in a complicated and rushed delivery eco-system

Take the 2000+ vaccination centres that opened up overnight to lead the country through a vaccination drive or the 1,606,569 tests processed in the UK between weeks 24th to 30th September back in 2020. This was service implementation at hyper-speed and an incredible feat to get set up across the country.

But some of you will have faced challenges when booking a vaccination or booster, maybe a centre didn’t show up on google maps. Or when arriving, there was no support for someone who had a hearing impairment or the literature was all in English.

A flow chart of who runs test and trace, sharing organisational names like Randox, Sodexo, Astrazeneca in blue boxes connected to each other to show who shares each part of the test and trace service delivery

The BBC got it spot on when sharing the eco-system of ‘who runs Test and Trace’;

“The name NHS Test and Trace sounds like it is one whole service that is part of the NHS. Nothing could be further from the truth.”

This is very true. Your user experience is actually delivered by 100s of different organisations, depending on where you live and what part of it you use. You might read information about how to get tested on a local authority site, be tested by someone from Sodexo and then be contacted by the Government, all the while tracking this with an NHS Covid app.

Designing and implementing a whole end to end service is really difficult when you don’t have full control of the design because the implementation of different parts of the service are run by different agencies, on different commissioned contracts, with different outputs detailed. In extreme circumstances like a pandemic, often design decisions like the marketing of it, the user flow, the interaction with staff, the information and guidance are all unconsciously designed because the service is being implemented at warp speed and by many people. Unfortunately you simply can’t be in every team meeting to express what good looks like, or what your users need (if you had time to do the research!)

You see this happen in every sector, for example the customer experience of using a first class airline comparatively to the organisation who find and deliver your lost bag is vastly different, because you’re not paying first class rates to the bag recovery company. The same service values might not be instilled in every part of your service delivery chain.

A stakeholder map for Test and Trace services at the heigh of the pandemic

The most important thing you can do at the start of any project, or whilst it is in flight is to map and understand who is actually involved in making design decisions that affect the user experience, what the key outcomes are overall and at each stage and how various systems link up to deliver it. Bonus tips for mapping the different legislative requirements especially if you’re a pan-UK service.

Retaining a live map or visual of a service showing the ownership of who delivers what as it evolves can be vital for anyone involved in the design and delivery of the outcomes you’re trying to achieve. This helps everyone to understand if we change something over here, what the effect might be over there. It’s also a good knowledge document for doing handovers in case anyone needs to take time out, just make sure someone owns it.

Standards can help improve fragmented services

Standards, patterns, exemplars of what good looks like is one way of multiplying the effect of one person’s voice in a meeting to help others consider their part of the service implementation. This can range from the best words used to describe a symptom to how to include accessible testing options for people when they arrive onsite.

So for this I wanted to say thank you to the teams who are setting standards to help people implementing services to work better for more people. I had the pleasure of chatting to Audree Fletcher who headed up Service Design at Department of Health and Social Care at the pandemic height and was doing the serious hard yards to challenge the eco-system of touchpoints across test and trace to make sure they are inclusive. Folks like Benjy Stanton who took up the new Head of Inclusive Design and Sophie Dennis, the Director of Human-Centred Design & Customer Experience at UK Health Security Agency are working in the depths of institutions to really push the accessibility and inclusive design agenda in all things test and trace. Thank you, that work is so invisible it rarely gets a shout out.*

*These are people’s works/blogs/direct conversations I’ve had about this but I recognise there are so many of you doing this work. Thank you!

Working backwards to fix unconscious design decisions

“Services are made of 1000s of design decisions before we even get to the point of designing the ‘user experience”

I’m a broken record when it comes to this statement. Every talk I give now revolves around this statement. Rarely, people get up the morning, come to work and think, you know what? I’m going to make a really shit service. Many of the contexts for which we design services in have often been defined long before we get ‘commissioned’ or asked to work on a project.

Earlier this year I wrote about Full Stack Service Design which is a map for considering all the ‘materials’ that affect how a service is designed, built and experienced. From policy to business model, technology stack to data models, organisational skills to business processes, all of these affect the end user experience, often before ‘designers’ start work on them.

The decisions that go on in policy, how we procure and grow teams, our business model logic all create conditions for us to make decisions with a certain intent. Multiply this across 100s of organisations who are running parts of these services, and you’re left with a constrained brief and often fragmented landscape. This might mean the technology stack you are building on might not allow you to do what you need to for users. Or the end to end design of a service has already been designed and elements of it are being commissioned before you get a chance. Why? Well it’s a pandemic and people just had to deliver it. In those situations you’re often left making a bad design, slightly less difficult for people to use.

But in reality, the latter is often what we end up doing when we design. Having to work backwards from a series of bad design decisions made way before we got there.

Book a vaccination form showing gender options in NHS branding

I’ve loved seeing my friend and ex-Snook colleague, Emma Parnell tell the story of the removal of the gender question in the book a vaccination service. They had to do exactly this, work back from an unconscious and innocent design decision. This might seem like a small, perhaps irrelevant detail to some but in reality, many people can suffer from gender dysphoria especially when being presented with questions that result in binary male/female options. In the case of a national vaccination booking service, this is a risk to a marginalised community in the UK. They did some digging and found out that the personal demographic service (which supplies the API for the service to collect this data) didn’t use gender questions in another service as Andrew Duckworth points out. After a series of late night stakeholder emails and this evidence, they managed to get this changed, not only on the form, but the underlying API. This kind of completely invisible work should be celebrated, because it does make a difference. So thank you to all the teams involved in this example to help make services more inclusive.

The real invisible work is reducing complexity

“With all the new services linking to each other, there was a risk we were making things too complicated for people”

Matt Edgar, Director of service transformation at NHS X, focused on the hard work the community of designers had been doing to make things simple for people who first suspected COVID-19 symptoms. This content design was essential to help people navigate the landscape of what to do, which services to use and in what order. So this is a thank you to not only the content people, but the digital, design, technology and operational teams who stuck by user needs, worked out the best way to create new products and services with the time they had and despite working at incredible pace, found ways to speed up their work, do it all remotely and still deliver user-centered designs.

Image from Hammersmith and Fulham showing distancing signage on the pavement

But with added complexity comes another challenge in how we decommission the complexity that was created, or make it part of our core infrastructure and user experience.

It’s easy when things are tangible. Take the 2m apart street signs on every pavement, park pathways, shopping centres. It’s a sort of pandemic anthropocene and at some point, we’ll need to say goodbye to it, but it is easier when it’s more tangible.

With new complexity in the form of new content, guidance, isolated products and services not centrally integrated, we need to be cognisant when and how to reduce this service complexity. When there is an ‘end’ in sight, or the pace drops from this emergency mode we will need to consider how to remove this.

So a future thank you to the teams of people who will do this work, and knit together the services that have been spun up so they’re more sustainable and secure in the future.

This was really just a love letter and a deep thank you to everyone involved in designing these vital services

Of course, thank you to all the frontline staff who are wearing PPE everyday to look after the really sick people across the country and the porters, the cleaners, the carers working at the frontline to keep this work happening.

So a thank you to all the invisible designers, working in the full depth of the stack to keep people safe, in tough working arrangements and at relentless pace.

This goes across not only NHS, but local Gov, civil service, charities. You’re doing the hard work to make sure we’re vaccinated, boosted, safe and have the support we need.

Thank you.



Sarah Drummond
Service Design Advent Calendar

Founder @wearesnook @dearestscotland @cycle_hack @mypolice | Service Designer + Boss | GOOD Magazine’s Top 100 influencers 2016|Google Democracy Fellowship 2011