Interview: Two Point Hospital Devs On Their Favourite Diseases And Slapstick Vomit

It had to happen someday. Ever since the business of reviving old games through spiritual successors became popular, we’ve seen plenty of Bullfrog titles get resurrected through arcane magic and turned into games that are worthy of their heritage. Theme Hospital was one of the strangest back in the 1990s, along with Magic Carpet, and so it was almost inevitable that someone would make that spiritual successor. It just so happens that some of the original creators have come back with industry partners to make a new one!

While we didn’t get to go hands on with the game at Rezzed, there was a huge amount to discuss in my time with Ben Hymes and Richard Brooks – two developers working on Two Point Hospital. You can listen to the whole, mostly unedited conversation below, but the key takeaways – of which there were many, have been written up. Given the fact this was 25 minutes, that says a lot about what they had to say.


TSA: It’s been over 20 years since the release of Theme Hospital, but it’s only really now that we’re seeing a successor. What took you guys so long?!

Ben Hymers: Hard to say really. Mark [Webley] and Gary [Carr] have been talking about it for a long time. They both left Bullfrog separately but kept talking about it, thinking of different Theme games, such as a Theme Prison, or Theme Resort. It’s only been a couple of years ago that the stars aligned and it was a good time to do a game like this.

We got together at Lionhead, me and Gary, started talking about this stuff because we were working on similar games. He took a shining to me, I enjoyed working with one of the original creators of Theme Hospital and it blossomed from there. He saw the writing on the wall with the closure of Lionhead and asked me if I’d like to start a new company with him. I of course jumped at the chance.

I then spoke to Mark Webley, who was a little less sure, he didn’t know there was such a demand for this sim game, but once we convinced him and raved about what kind of success Prison Architect, RimWorld and other sim games had, he was on board and we’ve gone on from there.

Richard Brooks: It’s amazing how these things can take time, because Mark started Lionhead and went down the Black & White and Fable route, and before you know it it’s 20 years and that game you were talking about back then hasn’t been done.

Ben: Yeah, they had both been working on stuff since then, Mark with Lionhead, Gary founded Monkey Foot and made Startopia, they’ve sort of kept one foot in the industry!

TSA: Well the stars have certainly aligned now, that’s for sure! I take it you guys were fans of the original?

Ben: Oh yes! I played it to death, me and my wife actually, and I still play it today. It was amazing getting hired by Gary at Lionhead and I was sitting next to him and he told me he was the artist on Theme Hospital – my jaw dropped. So yeah I’m a massive fan and it’s amazing to be working on a game that draws heavily from that.

Richard: I found out about it [Two Point Hospital] and I probably shouldn’t have found out about it, so when I heard about it, I thought to myself “I need to get in contact”. Fortunately I knew Chris, the lead animator, so I asked if they had any programming roles. He said they were looking for someone and gave me the contact details.

Ben: We couldn’t possibly overlook Richard and he’s a massive fan of the original game as well, so the perfect guy to have on the team.

TSA: I also have fond memories of the game as it was one of the PC games I had growing up. I still remember building my hospital and getting stuck trying to cure the invisible man. One of the things that drew me to Theme Hospital were the various illnesses that patients had. When you come up with diseases and the symptoms and causes behind them, since Two Point Hospital is similar in tone, is there a method to the madness?

Ben: I wish there was really. It’s just a process of spontaneously thinking of these ideas and riffing on them.

Richard: Quite a lot come from puns don’t they?

Ben: They do! We like a bit of a joke. We just think of words that would work as an illness name. Other times we think it would look cool if their illness looked this way. There’s all sorts of ways they can start off, but they all go through the same process of everyone chipping in.

TSA: Like a big whiteboard?

Ben: Yeah, stuff like the Curse of the Mummy, we don’t have a proper name for it yet. We’re thinking we might call it, if we can get away with it, Premature Mummification. It might get through, we’ll see! But that’s the level of humour we’re dealing with here, we’re all children!

But that one started with someone going “wouldn’t it look great if we got a mummy into the game?” and then Chris, the animator saying he could get some awesome animations for that, dragging his feet around and hammering on doors. That’s definitely one that’s come from a visual angle.

TSA: I was just wondering of causes as to why they’d be mummified and the best I thought of was that they contract it by read too much hieroglyphic text.

Ben: It’s nice to think of those silly ideas.

Richard: I remember before I joined, you may have seen the condition “Light Headed”, which I think was seen on the trailer. It was originally called “Bulbous Head”, but it never felt quite right. But the idea was good, the fact the head was replaced by a lightbulb. And I think it was someone we were interviewing just decided to call it Light Headed and we thought, “Yes, we’ll go with that!”

TSA: One of the other writers [at TSA] was wondering why the direction is silly and doesn’t depict real diseases such as cancer?

Richard: It’s a matter of being fun at the end of the day and it being a simulation, we want people to enjoy the game. It sort of goes with the humour from its heritage.

Ben: It’s a combination of things, partially nostalgia, but also real diseases aren’t funny. You don’t want to see someone with Tuberculosis. It all gets a little bit depressing. This is a light-hearted game.

Richard: And the joke is kind of on the characters and the staff members trying to treat them, and how the research department has come up with a ridiculous machine to try and cure them. It’s our personalities coming out.

Ben: We’re constantly giggling at how silly these concepts get: You just wake up one day and you have a bulb for a head!

Richard: Yeah and then to get it solved you’re going to get charged £1000 for it!

TSA: So you’re not afraid of any backlash?

Ben: No, you’d only trigger all sorts of feelings in people if you start poking fun at real things so it’s best just to avoid it. There’s a place for a game like that, but it’s not for us.

TSA: So in researching for this interview, I was looking at some of the old reviews at the time. Which, interviews written years ago didn’t exactly hold their punches. Some reoccurring criticisms are repetitive gameplay, the music looped a bit too much, and complaints about UI and AI respectively. Now this spiritual sequel is in the works, what are the lessons learned and what would you do differently?

Ben: That’s a whole heap of things there and we’re improving on all of them. There’s a whole lot more music there for a start! I loved the music from Theme Hospital…

TSA: Oh I did too!

Ben: So Theme Hospital had a rather linear progression, with a sequence of levels. The flow is completely different now with a non-linear structure. When you play through one hospital, you can then unlock a new hospital to go and visit and be running multiple hospitals at one time. Each level is no longer just completing the objective, there are three stars to guide you through the level and this unlocks stuff upon completing.  There’s also a ton of extra stuff to do along the way, so challenges to that will pop up from time to time.

Richard: There’s a lot of disrupting factors, so there’s special events that occur. The region of Two Point County, where the game is set, has a whole bunch of hospitals and they’re all set in different locations, one is set in the mountains for example and may have a lot of broken legs for example. Some health inspectors could be scrutinising intently too. You may also unlock new technology and go back to the original hospital to implement those upgrades.

TSA: Would you be able to return to those hospitals from the exact point you left them?

Richard: Yes. Every hospital is saved in is current state and you can build up an empire of hospitals.

TSA: So let’s say there’s a particular illness you can’t cure until a treatment has been developed in a later level. Would you then be able to go back and implement them?

Ben: Yeah, we’ve made every level completable at the point where you get to it in the game, but you may find you unlock other stuff that will help you achieve those goals a bit quicker. You may unlock new vending machine types that people like a bit more, so you can go back to the first level and stick those down.

Richard: You might get a hospital that’s in a cold region, so you can buy better heating systems. You probably can, if you’re really good, do the level without them, but that’s just an example of things.

Ben: We’re aiming to make it replayable though. It’s nice to go back and replay those levels and the game provides challenges that keep popping up, rather than just saying “you’re done, move on”. Then we’ve got optional online features to challenge your friends by setting targets, like who can earn the most money in a year, cure the most patients, that sort of thing keeps things fresh.

Richard: One thing I found exciting that’s certainly improved from Theme Hospital is the levels of simulation going on simultaneously. Characters and character interactions with patients now have a micro-behavioural system. It’s little tiny things that add to the humour, as patients walk past each other and affect one another.

Say they see something that might have an effect on their happiness. Someone barfs in the corner of the room, and one character trait may be that they don’t like seeing vomit. There’s emergent behaviour that relates to that, maybe not as horrendously as that one Theme Hospital level where you needed 20 Janitors.

You could also get staff members who are obnoxious, irritate everyone with every interaction. I don’t want to reveal too many, but there’s lots of character traits. Maybe they don’t wash their hands, spreading bad hygiene everywhere.

Ben: You wouldn’t want those people working in your surgery!

Richard: No, absolutely not! You may see this sort of thing in their hiring list. There’s lots of little things going on, but there’s also more major things such as the hospital’s reputation, which was in the original Theme Hospital, but it’s more detailed now.

Ben: Yeah, and there’s now an overall hygiene simulation in place and all sorts of other things that we have the processing power nowadays to actually do which makes for a more interesting simulation. It’s interesting to see how a crowd of people interact.

Richard: We’re hoping for a lot of emerging behaviour being shown on YouTube videos! We’ve had them just in the office!

Ben: They usually manifest in… bugs…

Richard: Sometimes you’ve got to say, well maybe they aren’t bugs! Maybe that’s actually brilliant and we’ll keep that in.

TSA: It’s not a bug, it’s a feature!

Ben: Well, people can slip up on vomit. It was a thing where characters would throw up and then immediately slip up on their own vomit, which is not how it’d go in real life, but we saw that and thought we’ll keep that in because it’s hilarious!

We did however have it set up incorrectly at first as an interaction point, which previously would have been used for an arcade machine. So you’d have people queuing up for the vomit to slip over it, someone slip over it, get up, and the next person in line would go to slip over it.

TSA: That just makes me think of Theme Park. “Come see the new attraction… a pile of vomit! That’ll be $50!

Ben: That’s amazing. With our animation, Chris, our animator, gets some awesome details there and the animation for slipping over needs to be visible from a distance, so he’s exaggerated them slightly. But they look like such painful falls! So you’d see this queue of people, before we patched it, slamming down on the floor. It’s hilarious to watch!

TSA: I really want you to just make that a toggleable option.

Ben: I’ll put a secret option in there.

TSA: Just so I can see it for myself really cause it sounds hilarious! So I wanted to finish off by talking about the involvement with Sega. Who approached who?

Ben: Well, it was me, Gary, and Mark trying to find funding for this game, we had to get money to pay staff and for an office! We initially thought of starting by Kickstarter as a route in. But after talking to some industry contacts, they suggested we would need more money than Kickstarter could have given us, at that point in time. There have been some huge successes since but it seemed like it was winding down.

So we ended up talking to some publishers, at the time I was working at Play Sport Games in Guildford, and they were published by Sega, so through them I got us a foot in the door and as it happens they were already having internal conversations saying that they needed to expand their portfolio of devs and they wanted more simulation games.

They actually said they wanted a studio that’s doing a Theme Park like game. Then we came knocking at the door and it seemed like a match made in heaven. We align pretty well on everything, they’re very pro-developer, not like publishers of old that dictate how things get done. They were really keen on us just doing what we do best.

Richard: They’re very experienced in what they do now, really making waves on the PC market.

Ben: That’s the other thing that sold it for us is their focus on PC. They have a fantastic QA and localisation team.

TSA: Yeah, they have that involvement with the studio behind Total War, so they probably didn’t need all that much coaxing.

Ben: No, they kind of jumped at it. It’s been great, the whole time, we’ve been very happy with them. It’s a match made in heaven!

TSA: At this point, what’s left to work on in the game?

Richard: We’re doing alright, features are in!

Ben: We’ve not got that many big things to put in, or even small things to put in. All the features are in, so all that’s left is bug fixing and polish because we want it to feel slick. Then there’s balancing which is going to be the big one. With a game such as this with so many systems in place, there’s a lot of emerging behaviour, so it’s a hard process. We’ve tried to give ourselves as much time as possible.

Richard: We’ve known that would be the case for a long time. It’s already been made a lot better in the last couple of months.

Ben: Our lead designer has done a fantastic job of wrangling the numbers. It’s fun to play now, but it’s just dialling that up and the case of making sure it works for short play sessions and playing for hours on end. This is the kind of game where those interesting interactions can explode and cause all sorts of weird stuff to happen.

TSA: So about the release date?

Ben: It’s this year. But we’ll announce more later.

TSA: I remember Theme Hospital coming out on PlayStation and that had a few issues with its controls. I take it then because of that it’s not really viable for Two Point Hospital to come out on consoles?

Ben: It’s a hard problem and we’ve thought about it, but we’re not really ready to say anything yet.

TSA: I suppose my final question is to ask, what’s your favourite disease you’ve designed?

Ben: I’ve got a firm favourite, but I want to hold off on that for the time being.

Richard: There’s a careful release schedule! For me, it’s one that’s already been announced, which is Light Headed, just because it was the first thing that I saw. When I went for my interview, they showed me the game and I was already excited about what it was going to be. Then I saw Light Headed and the game itself and was like, “This is for me, they’re doing it again”. With these guys, you can tell it’s coming from the same soul and heart.

It’s a bit cheesy, but you can tell and I instantly saw Light Headed and I loved the mechanical nature of it: Off comes the bulb, then they screw on a new head.

TSA: I have to admit, when I first saw that animation, I wondered, “How are they not dead?” and also “Where did they get those heads from?!” It’s the fact there’s a box of heads!

Richard: They don’t even offer the guy which head they’d want!

Ben: Congratulations, that’ll be $10,000!

Huge thanks to both Ben and Richard for taking the time to talk to us, as well as Sega’s PR for arranging the interview.


1 Comment

  1. I like the sound of the non-linear structure, I loved Theme Hospital as a kid, but I think now I’m older I’d fine the gameplay very straining.

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