As you may already have spotted, Theme Hospital joins the legions of 90s PC games being blessed with 21st century spiritual sequels. The Sega-published Two Point Hospital is the first game from Two Point Studios, the new endeavour from Bullfrog and Lionhead alumni Gary Carr and Mark Webley, Their plan, ultimately, is to follow-up Hospital with a clutch of other theme/sim/management games set in the same world – picking up, perhaps, where the Peter Molyneux-founded Bullfrog left off when EA closed them down.

I chatted to Carr, Webley and Two Point technical director Ben Hymers (himself an ex-Lionheader) about why they’re returning to Theme Hospital, why now, the importance of humour to it, what’s the same and what’s different, how the audience has changed since 1997, how they’ve been inspired by Prison Architect, Planet Coaster and Twin Peaks, and their plans for that world of sim games.



Gary Carr, co-founder: I’ve been in the industry since 1985, worked at companies like Palace Software, and Bullfrog I was one of the earliest employees when there were only six of us. I left Bullfrog and went to the Bitmap Brothers, rejoined Bullfrog, left Bullfrog and co-founded Mucky Foot Productions. Then I joined Lionhead, left them about two and half years ago to found Two Point Studios.

RPS: Did going solo happen because of the Lionhead closure, or did you jump ship before all that?

Carr: I had an incubation team, I just wanted to not work on Fable, I was done with it. Nothing wrong with Fable, I loved it, but it was all-consuming and I asked if I could have a small team to incubate new ideas. That’s when we hired Ben and what excited me about him was he reminded me of people we used to work with at Bullfrog. He would be very clear about what he felt worked, and I thought ‘yeah, this guy’s quite inspirational’ and said ‘if I was stupid enough to leave, would you be stupid enough to jump with me?’

Ben Hymers, technical director: I’ve got ten years experience in the games industry, started at Rare, ended up at Lionhead, and there we got together to form our plans to escape and start something better.

Mark Webley: I started my gaming career at Bullfrog, worked on a number of the titles, and got a chance to work with Gary on Theme Hospital back in 95. During that time, as we came to the end of making Theme Hospital, we were talking about the whole bunch of games we could do. We could do Theme Prison and Theme Resort and a bunch of ideas that were kicking around. But I went off and co-founded Lionhead, Gary went off to Mucky Foot and we kind of started working together at Lionhead.

Carr: even before that when you were on Black and White and I was on Startopia, we got rather drunk and giggly and started talking about ‘we should do this again…’ We really loved making those kinds of games.

Mark: That’s right. I left Lionhead back in 2013 and Gary came to me with the idea that him and Ben were kind of talking about doing this. That’s where Two Point studios got born – making these kinds of games that we used to make back in Bullfrog, these deep sims, but very accessible, don’t take themselves too seriously. I think the humour aspect is very important, it’s always been there in the stuff we do at Bullfrog and Lionhead, and I think we wanted to get back to that.

Certainly making Theme Hospital was probably one of the most fun times that we had, so that’s where it is.

Carr: And also not making it with a huge team. As Bullfrog got bigger it just made more games, instead of putting everybody on one project at a time. I think one of the secrets to bullfrog’s success was empowering really smart people. Back in the heyday of Bullfrog you had the Dungeon Keeper team, you had the Populous team, you had the Theme team, Magic Carpet. But we tended to be quite organic, everybody was involved, it wasn’t like we had a massive design document. You all felt engaged and informed in the process. That’s what we want to get back to with Two Point, it wasn’t so wrong back then, why can’t that be done again?

RPS: But if someone came up and offered x million quid would you turn down the chance to do this with a huge team and tons of resources?

Webley: Our team is about 16 people now. It’s not just us three. I think our journey to get here was initially inspired by Prison Architect. The approach they’d taken was early access, and just keep developing game ,so we thought maybe Kickstarter, early access. But we probably came a bit late too all that. The Kickstarter stuff was, one month ‘this is a great way to go’ but then next month ‘it’s a terrible way to go.’ Our initial thoughts about this was we need to get funding, we’re quite a small team and this is the way we could approach it.

We spoke to a number of people and some of the publishers we spoke to, probably some of the smaller publishers, thought it was a great idea what we were planning today, but there just wasn’t a lot of money around to help us do this.

Then we met Sega, we were introduced by Christian at Playsport, who’s kind of working with Sega and in fact Ben had done a year stint at Playsport while we were trying to get everything off the ground, and it was just a great time to meet them. We had developed our idea, and Sega Searchlight was at a point where they were kind of looking for this kind of title, this kind of business sim game, for the PC, to feed into their roster of titles.

Carr: Back to your point though, even though we’ve gone for a bigger team than the average startup could afford, I still think the methodology stands. Mark and I for example had run teams of 200 people, whether it was me as a creative director or EP, Mark used to be head of development and ran some of the teams. It’s just really difficult to get the same pleasure out of a game when you have 200+ people making some AAA title. We wanted something in the middle. The Bullfrog games were still considered AAA, but they weren’t massive teams. It’s just part of how the industry’s grown up over the past few years, the teams have got bigger and bigger, and therefore you’re more removed from the creative process. We just wanted to go back to that creative process.

Webley: We wanted to be involved again.

Carr: It’s a middle-ground really. I think some of the best ideas come when you work with great people and you listen to each other. It’s difficult to listen to everybody when you’ve 100, 200 people in the room. You start to become very closed off. We wanted to go back to that, because ultimately we’re game-makers and that’s what we wanted to do.

RPS: This seems akin to how, thematically, you’ve returned from a sort of cosmic approach with Startopia and Black and White, to something much more grounded and earthly.

Webley: Yeah, I mean my favourite genre from those three studios, if you want to put them under an umbrella, is god games. Fable was brilliant and it was great for Lionhead, but we just stopped making some of those god games that we used to love and we thought there was a real opportunity to go back to something in this genre.

RPS: Why back to hospitals specifically?

Carr: Just because, we’ve got a bigger picture here, and this felt like a good starting point. We want to build out a world of sim games, and this seemed like a good starting point because of our history.

Hymer: I personally love sim-type games. These guys obviously do, they’ve been talking about going back to them for years and years, and it seems like the industry is ripe at the moment. There’s lot of sim games coming out but none of them are quite how we’d want to do them .They either miss the point with the humour or lack some of the depth. We felt like we’d like to have a go at doing one our way, and with hospitals there’s obviously the nostalgia there, we’ve got some of the original guys that worked on Theme Hospital, so it just seemed like the obvious choice to get back into it.

But that’s not the be-all and end-all of it. We’ve got all sorts of ideas for various things that happen in the same world, we’re sort of working on this first piece in the puzzle. We’re creating Two Point County, a little world in which lots of different things happen, there’s characters that are going to be part of the world, and we’ve got plans for all sorts of different bits and bobs for it.

Webley: Gary always talks about it well – imagine in the Simpsons, you’ve got Springfield, and you’ve got the different parts of it – the power plant, Moe’s Tavern, and these kind of exist in quite rich settings of their own, but they’re all part of this one thing. The idea of characters that go from one of your sims and end up in hospital… That’s kind of a longer-term plan, but it just seemed like a good starting point for us. I’m sure as you know from talking to a lot of start-ups, it’s hard to get noticed and we’re fortunate we’re with Sega. We’re doing something that we hope people will be interested.

Carr: We knew with Two Point County we would at some point build a hospital facility in our linked-up world, we just thought it was sensible to do that first because it was one of the things we were known for in our past. Our bigger picture is to be multiple themed sims within Two Point County.

RPS: Just how, dare I say it, Molyneuxesque are your plans in that regard? Will elements and savegames and decisions carry over between games?

Carr: We’ve got an acorn, and we plant it here one day… (all laugh). To be honest, we could never really think outside the box like that. Pete is classic at coming up with these big visions, but ours is a simpler message really. Rather than make a sequel to a game, we want to make something else that lives thematically within the world.

Even though thematically it shares a relationship with something we made back in the day, it’s a very different experience. And the game we’re going to make next will have differences. None of us want to reskin and make the same games we’ve made before. We have to move on, evolve it and make it more interesting, otherwise it’s not really worth doing. We might as well just farm it out to someone else. This is not going to feel like something we’ve played before, I don’t think.

RPS: Tell me about the origins of the game – and studio’s – name. It seems to me to evoke both ‘2.0’, perhaps a pun on coming back to sim games like this, and looking at the environments in the screenshots, maybe Twin Peaks too?

Webley: (laughing) that’s actually our thought process completely. We must be very transparent.

Carr: Actually, I’m going to be really honest here. Mark hated the idea of the 2.0 thing. He thought I was just being very negative and bitter and twisted. He really liked the idea of a world, a bit like Twin Peaks, creating a physical element to the county, like a landmark. So we’ve evolved it from possibly a little bit of cynicism into something more positive.

Webley: We kept going back to Twin Peaks as perfect. The logo of the game is two mountains.

Gary: and if we are going to create something Springfield-esque, you need to create a little bit of lore and backstory. It just felt a lot more rich to have this town which had some landmarks, some traditions and characters and something that makes you think that can wrap story around it. We didn’t want this to be a level-based sim, we wanted it to be rich and varied. In the modern age of gaming there are constant opportunities to add content, so want to wrap that around something rather than just create thirty levels of a sim game.

RPS: you’ve said you don’t want this to be just a reskin. Can you give me an example of features that go beyond the nostalgic?

Carr: We absolutely wouldn’t do real illnesses. That’s the main touchstone, I guess, you’ve probably seen in the trailer. When Mark and I originally got together on this idea, we didn’t originally have made-up illnesses and made-up cures, we were looking at a real healthcare simulation and it just didn’t seem right back then either. We’re not doctors so how can we create a simulation? We make things up, that’s what we’ve always done. We didn’t want to put something in a real-world setting because we’d get it wrong, so we were always going to have to do that trick again.

And also it makes it much more fun and interesting. Who wants to play a real illness simulation? It just doesn’t make sense to me.

Webley: Yeah, at the heart of it you’re running a hospital. You’ve got patients and you’ve got doctors and you’re building up things. At that kind of level you can say it’s similar, but there’s a lot of other hospital games since we did Theme Hospital that have done a similar thing maybe, but I’m not sure they’ve completely got it right. I think the humour is really important and the depth of gameplay, making sure it’s easy to get into very quickly…

Carr: Some of them have been too dry. I hate criticising other people’s efforts and I’m not meaning to, but from my point of view it’s about the marriage between giving someone a rich, deep sim game but not necessarily making it po-faced or stiff and difficult to get into. We had a lot of feedback from people who were playing our games but had never really played sim games before, because ours felt quite easy to get into due to the humour and the visual approach we went for at the time. I think that’s what we’re trying to do again, make something that feels accessible but for more hardcore games there’s also something for them too.

Webley: I think the overarching game structure is rather than a linear experience where if you get to level 4 and you can’t progress that’s it for you. We kind of wanted to make sure it wasn’t a really straight path through the game. The ability to go back as you build up your healthcare foundation, your business with a number of hospitals, you’re able to go back to those hospitals and perhaps you didn’t max out the number of stars you got. So you might you get one star and then maybe move on because getting the other stars is too difficult, but as you get more experience you might come back and play that

And I guess twenty years of experience making other games and inspired by some of the other stuff that’s been around, we kicked off saying we were inspired by Prison Architect and then there are games like Planet Coaster, which are incredible pieces of work. And there’s Cities: Skylines… We’ve been inspired by a lot of stuff.

RPS: In terms of humour, the comedy of 1997 is pretty different to the comedy of 2018. How much does Two Point reflect this?

Carr: I’d like to think we’ve updated it. And the thing is, we work with some people, and we’ve got some new smart people and some old smart people, and you’ll have to be the judge of this, but I hope that the humour feels right for today. Obviously what we did then, perhaps it was a little more Carry On; I think it’s a little less Carry On now, you do have to modify your thought process when you create games, but not try too hard. Ultimately it does mirror the team.

Webley: I think it’s the stuff that makes us laugh. It was the stuff that made us laugh back then. We worked with a guy called James Leach back then as a writer, and he had quite a strange kind of sense of humour and I guess we did, we liked Monty Python, but I think nowadays a lot of that stuff seems old-fashioned. I think [for this game] it’s off-kilter, things like Alan Partridge, a lot of modern comedy.

Carr: It still feels quite British, but not necessarily sitcom British. I’m not saying it was back then, but I think we were playing with that kind of humour a little bit then. I think it works still, and we try it out on ourselves but we have a lot of help with that now. There was no real censorship back then, we just used to make a game and release it, no-one seemed to be that professional, if I’m honest. We are mindful that we have to make this work across a number of cultural differences. There are differences in humour around the world, but I think if you try too hard it just doesn’t work.

Webley: I think that’s the thing. I think the humour is… we’re not trying to make the game funny, it’s just a little bit off, something’s a bit weird about it, and I think that’s where it’s come from rather than it’s about jokes.

Carr: It’s more to do with visual gags. There’s a lot of humour in the way we animate the game. Playing with puns. It’s a bit like silent movie comedy; it kind of works today in games because if you can make the animations quite theatrical and really amp up situations. It’s sort of a bit slapstick. But yeah, we’re not pretending to be comedy writers, but I think it still works.

RPS: An example comedy disease we see in the trailer is ‘Light-headed’; how would that be cured?

Carr: I guess the process for all our illnesses is wordplay then trying to think of a visual around the wordplay. So light-headedness actually wasn’t born out of the obvious pun there. We originally had this sort of bulbous head and we were playing on the term ‘bulb’ rather than ‘light-headedness.’ But actually Mark came up with light-headed as a better name for it. So our process is that, our pipeline for these is ideas just playing around, think about a visual, think about how you would cure that visual, make it surreal, have fun with it. Some work and some don’t. Some sound good paper and then you try and make the visual and it doesn’t quite work.

One of the longest processes we’ve had with this is we’ve had the list of ideas from day-one, we’ve just kept building on possible illnesses and possible cures. Some of them go into a sort of pre-production where we’ll sketch it out and do a story board, and then we either fall out of love or love them more. That’s kind of the process we’ve done. That’s how it used to be as well. We didn’t sit down and write a design document.

Webley: In Theme Hospital, one of my favourite illnesses was Bloaty Head. That’s a crummy name, because you just had a bloated head, but the thing I liked most was the animation of popping the head and then reinflating it. That was lovely. Nothing particularly funny about something called ‘Bloaty Head’ for someone with a big head, but…

Carr: It’s just a bit slapstick. We’ve got cartoon humour, the classic Tom & Jerry iron in the face so the face looks like an iron after gag. It’s been around for a hundred years, but in games it works still. You can still play with that humour where perhaps it looks a bit past its sell-by date on TV. People still love to see these things in games, I think. Being able to inflict cartoon injuries on people is funny.

RPS: To what extent have changes in the real world affected things? These days we’ve got NHS underfunding, American healthcare controversies, whereas hospitals and doctors seemed a lot more aspirational in the 90s, when there were all these glossy soaps about them…

Webley: funnily enough, it hasn’t changed at all. I think all the issues around the NHS were really prevalent then. As we researched the game and got our inspiration for the original Theme Hospital, there were doctors’ strikes and just a lot of stuff that’s still around now. Whether it’s more in the mainstream now I don’t know, but it seems exactly the same.

Carr: We were really surprised when we did research for the game back then how competitive and how businesslike healthcare was. We were speaking to some of the managers of these hospitals and they were saying they were really hoping to eat into Guildford’s catchment area. They’re making it sound like they’re farming illness. But that’s what you have to be, you’re a business, you have to be competitive, so they’re saying ‘yeah, we’re managing to take a lot of patients off Hampshire’s hospitals and bringing them to Surrey.’ So we were saying ‘by curing people and sending ambulances to these incidents, you’re actually making it take longer to get them to hospital than sending them to the more local hospital’, and they’re going, ‘yeah, but it’s survival of the fittest, we need to grow our catchment area’. And you’re just thinking ‘this is crazy.’.

Webley: I guess 20 years on there have been a lot of hospitals that have been absorbed by other hospitals.

Carr: So you can imagine, that’s why we didn’t do a serious hospital sim. This is really quite dry.

Webley: It’s a relevant story now, and that’s quite a good topic for making a game. People know hospitals, probably everyone’s visited one and complained about it, probably think they know how to do it better. So it’s not a strange topic where someone’s not going to know about.

Carr: We’ve always said that a good sim game is a relatable subject. Normally they get made into things like situation comedies or soap operas. They’re normally really good subject matters for a sim game.

Webley: Is Casualty still going?

Carr: Holby City is.

Webley: Back then there was Casualty, and there was something called Angels.

Carr: And there was ER.

Webley: I guess back then they would have been the sorts of reference points, but things like Scrubs have come out, and House.



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RPS: how representative of the game are the trailers and screens you’ve put out today?

Carr: The end 10 seconds of the trailer is all game footage. Shot probably about three months ago, when these things start. The game is pre-alpha where we are, but pretty much content is in for the whole game. Obviously it will improve and look better. I think the game’s going to look very pretty, actually. It is pretty now, so it’s only going to get better. That’s representative. It represents the humour, and our style has that slightly plasticiney feel…

RPS: I noticed a bit of an Aardman (Wallace & Gromit, Sean The Sheep, Early Man) inspiration in the characters.

Carr: yeah, that’s fair, it is that. What’s great about Aardman as well is the kind of visual comedy they do, it reminded me of what we tried to do with the original game. And the fidelity we have now, and the ability to push on the visual front, it felt like a pretty good reference. So no apologies there, that definitely is the way the game looks.

I think you can see the relationship between what is pre-rendered stuff for a trailer and the in-game stuff. The studio that produced that for us, they were looking at the game and saying ‘does this represent it?’, and I feel it does, yeah.

RPS: why do you feel management sims in this traditional vein fell somewhat fallow?

Webley: Well, I guess we’ve still got stuff like Prison Architect, and Cities: Skylines and Planet Coaster.

Carr: I think these things are circular, they come round again. We feel it’s time to do something like this again. Ultimately, to be honest, we’re not trying to create a fashion for this. This is just a game we want to make, and if people want to play it, fantastic. I don’t think we’ve ever made anything where we were ‘what’s going to be the zeitgeist in two years’ time?’ We’re not very good at following trends or defining them. So it’s a game we want to make, most importantly. Obviously it’s a business and you want it to do well, but we were going to make this if we could anyway.

RPS: what’s changed in terms of audience needs and expectations since the last sim game you made? Why has Prison Architect worked when others haven’t, for instance?

Carr: You never really know, do you? We’ve never left the industry, so we’ve hopefully evolved in parallel with trends and expectations, but I don’t know if I’ve ever sat down and rationalised it and thought ‘you can’t do this and you can do that.’ Hopefully we’re doing the right thing, but you just don’t know.

Webley: I think different to 20 years ago, there’s a lot better ear to the community, and for what people are liking in your game. Certainly Prison Architect has been able to kind of put something out, pick up a group of people who became pretty hardcore fans and then evolve that into something that picked up more and more people along the way. I guess Planet Coaster’s quite a marvelous piece of engineering.

Carr: And they’d evolved that over a number of years, that engine’s been around for a long time, they know what works really works within it, and they’ve gone for a far more visually pleasing, rich world. We’re somewhere in between the two, I guess.

RPS: With those games they’ve particularly succeeded at keeping people playing for a very long time, which wasn’t necessarily the case with the level-structured Theme Hospital. How much sense of the secret sauce that goes into that do you have?

Carr: We didn’t know, Mark and I, when we made that game twenty-odd years ago that people would still be playing it today, and it would still be charting in Good Old Games, up there with games that are only a year or two old. We had no idea. And i don’t think you could necessarily recreate it. I hope we haven’t tried too hard. I think if you were really trying to emulate yourself, it wouldn’t work. We listen more to other people than ourselves in the studio. There’s no point in thinking you know what the secret sauce is, because probably you don’t.

Webley: Yeah, I think part of the secret sauce, if there is one, is just playing the game, tweaking it and playing some more, and just going over it so many times. Almost like a veneer that you’re layering on top. Like Gary said, we’re pretty much feature-complete, and hopefully that gives us enough time to be playing and tweaking, getting the pacing right, the balance right, and I think underlying that is the depth of when you’re enjoying something to be able to delve down into it. If you’re just interested in making a beautiful-looking hospital that’s functioning OK, then you can do that. And I guess the humour is just not taking itself too seriously really. That’s more the approach. Nothing is off-limits really.

Carr: Thinking about that, the one comparative thing from making the Theme games back then and what we’re doing is we were using quite old tech back then. It was an engine that was built for making Populous originally, I think. It was a sprite draw really, and Mark and I sorted of inherited that. It was probably on its fourth or fifth game by the time we picked that up, and back then games were moving into 3D, so people were writing in-house graphics engines.

So we had the time to balance the game here because the engine wasn’t being written during development – we’re using middleware now. It’s difficult enough to make games anyway, but having to write an engine too was always a nightmare. So we’ve managed to take some of the pressure off ourselves trying to write tech so we can focus on gameplay, which I think is really important.

RPS: What engine are you using?

Hymer: Yeah, we’re using Unity. There’s pros and cons to everything, but it’s given us a good baseline of technology to be able to do a lot of things that Theme Hospital couldn’t. Ideas that would have been ruled out back then for not really being feasible with the engine, but having Unity with all its features, particle engines, renderer etc, just makes a whole load more options available to us. We considered Unreal as well at the start, and the team’s got a lot of experience with it, but it’s well expensive. (laughing)

RPS: What kind of release date are you looking at?

Webley: We’re sworn to secrecy on release dates, I’m afraid. Later this year is all we’re allowed to say. We’ve got an alpha date coming up in the next two or three months.

Carr: We knew what the features list was going to be, and it’s always the easiest part to hit your feature list. Now it’s the hard work, which Mark’s alluded to, and it’s finding the fun and making it the best game it can be. We are hoping to make something that has a long lifespan and we don’t want to sell ourselves short. The unknowns are how to make it the best game ever. It’s got to be a good game, there’s no point making an average game.

RPS: Will you go straight to full release, or are you considering an early access programme?

Webley: Oh I think it will be a full release. We’re thinking that we’ll probably do a closed beta.

RPS: Can you name the most-demanded fan feature you’re realising this time around?

Carr: We didn’t want to throw away the charm of the original, but this its own entity. Whenever you read back about the game, it’s always nostalgic and people remember things slightly through rose-tinted spectacles, but people did talk about the humour a lot and I think we’ve managed to do that again.

Hymer: There’s the camera controls, and the final level you can complete now.

Webley: That’s right, I think a lot of people might have dropped out around level 5 or so, so I think getting that balance a bit better. There was one shot at it, and that was when we released Theme Hospital. No updates or patches or any feedback or analytics stuff. That’s what we’re hopefully really going to get right.

Carr: I also think there are a lot more ways to play this than the original. It feels like you can play it in a number of different ways and get different results. Which was my negative about the original – I felt I had to play it a certain way. So I think we got that right.

Webley: And I think there were a lot of things in Theme Hospital that a lot of people didn’t even know about. I think we’ve done a much better job with our user interface.

Carr: But I still hope it will appeal to people who just want to have fun, with a more sandboxy approach, but people who are sim players will get that challenge as well. And there’s definitely more customisation now, there’s way more assets to place. We were limited by the fact that I could only draw so many things back then.

Webley: Well, we were limited by having only four megabytes of memory.

RPS: Thanks for your time.

Two Point Hospital is due for release later this year, published for PC by Sega.