It’s always my favourite part of the medical drama. The bit where the patient is flatlining, the heart monitor goes from the steady, recognisable rhythm of a fading pulse to the relentless, whining beep that means the worst. Then, all of a sudden, the doctor in one final, defiant attempt to cheat the uncheatable yells ‘Clear!’ and jams the defibrillator onto the patient’s chest; they suddenly, climactically burst to life and what once seemed hopeless has now become miraculous.

Such is the tale of Theme Hospital and the short-lived prevalence of the comedy medical simulator. Once one of the most unlikely success stories of ‘97, the future of the Theme Hospital series – as well as the Theme brand itself – was effectively terminated when lead designer Mark Webley left Bullfrog Productions to start Lionhead Studios with Peter Molyneux. The next 21 years were one big what-might-have-been for the Theme Hospital series, one of the most notoriously sequel-less games in the industry’s history. That was until 2016 when Webley and fellow former Bullfrog, and Lionhead Studios alumni, Gary Carr, reunited to continue the legacy they started in 1997. They founded Two Point Studios and began work on their spiritual successor to Theme Hospital.

Upon first glance, Two Point Hospital is almost indistinguishable from its inspiration. You begin the game by reciting a familiar pattern. You place down a reception and hire an assistant to be stationed there; you build a GP’s office and find the best doctor with the diagnosis skill; you search for a Nurse to work in the newly constructed pharmacy; and so on, in a remarkably similar fashion to its 22-year-old predecessor. Suddenly, a familiar feeling of panic sets in as the patients are queueing outside the fracture ward but then the x-ray machine breaks down. You then have to use an already dwindling pile of money to hire a janitor to fix it, put out the fires and clean up the patients’ mess. Who knew sick people could be so unhygienic?

However, the game does differentiate itself from its predecessor in some important ways. In the first game, each level could only switch up the challenge by unlocking more rooms and having a slightly different shaped space to design your wards in. In Two Point, each region comes with its own set of challenges. One hospital is built on a fault line so it’s prone to earthquakes. You have to hire more handymen than usual to fix all the equipment broken in each disaster. Then there is the teaching hospital that demands every doctor and nurse you hire is a junior so they have no qualifications and have to be taught manually. This was my favourite because it allowed me unprecedented access to customise my workforce’s skillset, challenging me to identify gaps in our expertise and filling them whilst also figuring out how to compensate for having four nurses spend a month in a training facility, rather than looking after patients.

Not every condition is a winner though. At their worst, these challenges feel like busy work instead of an intensive mental exercise. In hot and cold regions for example, you need to place either heaters or air-con units around the hospital, and while it challenges your spatial awareness, too often it just ends up feeling like another piece of admin you have to keep up with in every room. Then there are the challenges such as ‘cure this many patients’ or ‘earn this much money’ which feel like wasted opportunities as curing patients and earning money is the point of the game in the first place and the spaces these challenges occupy could have been used to add more variety.

Two Point Hospital is a game about building a house of cards. Each card represents a different system that keeps the business ticking and the patients healthy, but when one goes wrong, they all go wrong. The initial build-up is very calm and evenly paced. You have plenty of time and space to begin building the hospital up, gradually getting your staff together, and arranging the rooms just how you want them. But then you discover three or four new diseases that all need rooms of their own. You may need to build a new wing to accommodate them, and hire new doctors to attend to them. This means your hospitals starts accepting all manner of patients, from werewolves to clowns to people with pans stuck to their heads, and the pace accelerates immeasurably.

Then Two Point becomes a cycle of dealing with one issue after another, much like the real-life running of the NHS, only I can’t imagine our Health Secretary personally doing all of the interior decorating themselves. You realise the hospital is dirty so you have to reprioritise the caretakers’ schedule to clean up the mess; there’s no one working in the psychiatry ward so you need to find a doctor you can spare to reduce waiting times; and so many patients have died your hospital has become haunted. The most constant and pressing issue however, is that the GP’s offices need constant attention as that is the bottleneck every patient passes through multiple times. This means that you have precious little time for the game’s greatest joys, decorating the rooms and spying on the staff and patients.

Adorning the rooms is a delight as due to Two Point’s eccentric collection of assets, it not only becomes a creative outlet but an exercise in strategy. How do you take a tiny space and make it attractive and functional at the same time? Several items have their own stats too, such as the three basic forms of houseplant that each have their own attractiveness rating, but the prettier they are, the more they need to be watered. Or an anatomy model that helps students in the training facility learn faster. More items are available as you earn Kudos, the game’s secondary currency. Like the name suggests, Kudos is earned from completing challenges, thus increasing your reputation. Now you have them unlocked you can buy them with the money the hospital has earned through curing patients. But if you want an extra layer of customisation, there’s a free pack out now too that lets you create your own designs and share them with the community. Now every room in your hospital can look like the set of a kooky 60s spy adventure.

The attention to detail in the game’s models and animations is constantly surprising and often hilarious. From the patients with ‘Mock Star’ dressed up like Freddie Mercury and moonwalking their way down corridors, to the clowns who can’t go anywhere without falling foul of slapstick shenanigans, each new hospital is like a procedurally generated Aardman Animations’ film. The treatments are even more impressive as someone with ‘Light-headedness’ might have their literal lightbulb head screwed off and replaced with a more conventional one, and just watch a patient in for an injection squirm as they see the needle abruptly puncture their buttocks. The first time I saw a receptionist run like Usain Bolt for the loo, I was in stitches. It showed me that the developers took every opportunity to wring as much personality out of the game as they could.

The problem then becomes that, in my own experiences playing the game, I ran into the same issue in almost every level. Rapid expansion was necessary to meet the needs of every patient and in doing so, I found my managerial duties were rushed and uncomfortably hectic. The reputation of the hospital was through the roof which meant we were constantly attracting more patients than we could meet the demand of. The game then followed a loop of having to constantly sort out the lines of patients piling up outside the GP’s office in-between dealing with every crisis a busy hospital has to offer. Even as the corpses piled up, the corridors became biohazards and the malfunctioning equipment was killing more people that it was saving, my hospital’s reputation refused to diminish, even as we sank further and further into debt. I kept failing by every metric, but my hospital was still filled with more optimistic sick people than the Church of Scientology.

The brief time I had at the beginning of each level to indulge in its two biggest selling points was over all too quickly. The feeling of losing control is essential in a business simulator, but in Two Point Hospital it was the predominant experience in a game that felt designed to be much more casual. The impressive amounts of thoughtful systems that have gone into the game, such as the effect on hygiene a doctor can have if they refuse to wash their hands, or how staff get depressed if the space they work in is boring, are awe inspiring when things are going right, but equally as maddening when things are going wrong.

The trouble is that the game is so full of interlocking systems that deciphering what is going wrong can be a lengthy and laborious process. Even worse, is that taking the time to do so makes stopping to smell Two Point’s roses impossible. Having to rush your way through building rooms, instead of making them prestigious and pretty is wholly unsatisfying and having to sort out the various issues in the hospital means you miss some of the more colourful interactions. For example, various Two Point trailers point to staff members having arguments or slipping on vomit. Despite spending several hours with the game I’ve yet to see these types of interactions because I’ve been too busy running a medical facility.

Ultimately, Two Point Hospital is a victim of its own success. They set out to create a community of poorly humans who are both adorable and quintessentially British so that you would genuinely care about making them feel better. And I did care about the fates of these lowly little Hobbits like I was some sort of drug peddling Gandalf. Unfortunately, the act of looking after every single one of my charges meant that the time I had to truly appreciate them was severely diminished. Even worse, I had to leave most of my rooms looking like they were as bare as Marie Kondo’s bathroom. Two Point Hospital has been a triumph and so many have fallen back in love with its quirky charms. I just wish that looking after a community’s health was simpler so that I could spend more time enjoying the act of actually doing it.

Two Point Hospital is out now on Steam and half-price until 9 July 2019

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