Steve Leard on Designing Sick-Note Britain

Steve Leard is a graphic designer based in Plymouth, specialising in book design, branding, illustration and typography. Here he talks us through his creative approach to designing Sick-Note Britain.

Sick-Note Britain (Hurst Publishers, February 2019) is an urgent call to reform Britain’s sickness culture, offering social – not medical – solutions. The author sees the book as a blistering condemnation of a sham system that works for nobody.

Hurst gave me a pretty open brief, which for me is ideal as it allows me to try a wide-range of approaches.

With a book like this, there’s a number of obvious routes that initially come to mind. I often find it useful to get them down on paper, if only to rule them out and move on to more original ideas. The most obvious was a shape of Britain made out of a crumpled note. This seemed to tick some boxes, but for me these were shallow, a bit flat and didn’t have the necessary impact. 


I also tried some options using the instantly recognisable Union flag. The one of the left which links the flag with the red hospital symbol was a nice ‘smile in the mind’ idea, but like the previous options, these two seemed too obvious and perhaps playing it a bit safe. 


Hurst highlighted the brilliant 4th Estate cover for Bad Pharma as a comparison, so I tried some options inspired by this approach. What I liked about these are their simplicity and confidence. It also created an opportunity to include small touches such as the ‘not easy to swallow’ lozenge on the pill box cover, which reflected the provocative nature of the book.


I photographed some blister packs from pill packets. I particularly liked the one on the right with the title repeating across the pack. In fact, I think it was my favourite option during the process as it felt like an original and fresh approach. Hurst also liked this cover, but I think maybe they ultimately thought it was too subtle and the title didn’t shout enough. One for the killed covers collection!


I tried some options simply using pills to frame the copy, as well [as] using the actual statement of fitness to work that doctors need to fill out when advising an employer that someone is going on statutory sick pay, which was a good vehicle for the copy, but ultimately wasn’t striking enough.


After progressing from using the fitness to work form, I tried using a photograph of the green prescription form. This became a useful visual tool as it’s instantly recognisable to most people in the UK. 

Like the fitness to work form, it was ideal to place the copy within the form and it essentially designed itself. From early on, this was Hurst’s preferred route.


I originally had the title written out by hand as this seemed more human, but the author wasn’t keen, so we reverted to using regular type. It’s peculiar as it seems so many U.S. covers use handwritten type on covers – even on serious non-fiction titles, but I’ve struggled in the past to get anything handwritten approved, even when there’s a clear logic to using it.

I like the hidden details such as the digits at the bottom of the cover being the ISBN number. I like these things that as a designer you can sneak in, knowing that pretty much no one would notice it, but those details seem to matter so much.

The end result is a cover that’s simple and straightforward, but hopefully also impactful.


Final cover


Design Editor, Painter, Designer, Lifelong bibliophile.