We’ve all thought it at some point in our lives, “How hard can it be to run an entire hospital and health care system?” and thanks to Two Point Hospital you can live out your fantasies of being a PFI contractor and be left in charge of a number of hospitals to build from the ground up, and damn the consequences. That is until you start damning the consequences and everything is on both literal and metaphorical fire.

Two Point Hospital is the spiritual successor to Theme Hospital, a game from the past, which was a fun management game about building hospitals to deal with a number of delightfully dry outbreaks of British humour and there’s little difference here! Two Point Hospital continues to be a management and business simulation game, filled with graphs and economies and things that are actually fun, like curing disease! Patients will come in with lightbulbs for heads and you’ll chuckle and then proceed to remove their head as that’s the only treatment available. It’s fun and it is silly and will leave you chuckling sensibly throughout.

However, Two Point Hospital is also remarkably cutthroat and mean, and sometimes all too baffling as your fully functioning hospital spins on a dime and crashes into the dirt and you’ve gone bankrupt, such as that of Carillion, except you’ve not made off with a number of juicy bonuses and you were actually trying to make a good hospital.

Things are relatively simple in the world of Two Point Hospital, you’ll need to buy chunks of land to turn into hospital grounds and begin carving the land up into specific rooms for different functions. You’ll be placing a number of GP offices and pharmacies and the treatment room that removes pans from people, it’s all pretty standard procedure. You’ll also be buying a number of staff to run these rooms and then desperately hope that the right people go to the right room because you didn’t spend ages training one doctor to be a great GP only for the junior doctor with no experience to sit in their seat and live there forever.

If you look closely, you’ll see that there are a number of hell beasts, or as the French call them “clowns”, in this image.

Beyond just simply allocating areas to be rooms, you’ll also be outfitting the entire hospital, including the rooms. Placing down benches, so patients can sit and wait for literally an entire year awaiting treatment, vending machines, bins and several thousand pieces of identical artwork. You can spend a large amount of time carefully preparing each and every part of your hospital to make it look beautiful and nice and it feels great. I took to great lengths to make my GP offices have a nice number of windows and tasteful art on display, all while having additional seating, if anyone just wanted to have a sit.

Part of this is down to wanting to make things look nice, but also the more stuff in rooms the higher the prestige of the room itself which serves some function that will never be divulged to you during the game. Potentially making business run smoother? So then you have to start wondering if you want to make the rooms a bit bigger to fit more stuff in them, but then you’ll also run out of space to put MORE rooms. You are constantly struggling for space in Two Point Hospital and it is wonderful as there’s always something you need to build, but where to build it is a constant struggle.

Every good staff room requires less than 1 meter between each human body.

You’re not just simply building one monolith of a hospital though, as there are a number of levels throughout the game, each with their own dry and witty introduction, that’ll have some number of challenges for you to solve and these can be oddly interesting. One level sees your entire funding come from the government and by fulfilling the flippant whims of the health secretary. If you don’t water 10 plants then you don’t get the next part of your funding and everyone begins dying, sorry, those are the rules, this is a Tory government.

These levels are also how you get more and more diseases introduced to you for your doctors to grapple and tie to the ground, which is what I assume doctors do. However, there comes a point where the levels don’t have many major differences between them, they’ll just introduce yet another new disease that has a unique room for that one singular disease which is a bit naff as more and more of your hospital is taken up by a room that treats one single disease but requires a full member of staff, but also that room may not be used that frequently, so enjoy your wasted space.

You wont be storming about in boredom induced rage, probably just money induced rage.

It is probably hard to come up with a number of distinct illnesses that are resolved with a big screen that turns peoples from pixels to flesh, but also maybe they should? Watching each of these machines and processes work is wonderful the first few times and adds a level of joy to the game as you watch someone made entirely out of cubes, suffering from Cubism, get dismantled then stuffed into a big sack and they’re right as rain, like a human shaped sausage.

There comes a point where all the whimsy fades away into hard numbers, and this isn’t entirely down to just the player, it is down to the game itself. The challenges that the game will throw at you require a decent amount of hard graft, as well as the game’s own internal systems that spiral out of control faster than they should.

All too frequently you’ll have a thriving hospital with several million dollary-doos in liquid assets, everything running smoothly, waiting times are manageable and very few people are dying and turning into ghosts. It’s what I assume is the least you could ask for in a hospital. Very few ghosts. That said, there would come a point where you’d place down one more GP office to just even things out a small bit and instead of cutting waiting times it would put the hospital’s level to 20 which the game apparently reads as some crisis state as you’re flooded with patients and the queues for services skyrocket. Suddenly no one is getting treated for anything and everyone is dying shortly after seeing the GP for the first time and there are ghosts everywhere.

Well, this doesn’t look good….

No matter how many GP offices and doctors you hire to tackle this problem the numbers never go down, except your income which begins to spiral downwards and you’ve gone from having millions to being bankrupt and you’ll have no clue as to why this happened, other than having too many patients so nothing got done because everyone is too busy dying and being haunted by ghosts.

Upon closer inspection you’ll learn that nearly every patient is in this endless loop of seeing the GP, going to get a further diagnosis in another room, coming back to the GP, going back to a different room for further diagnosis, back to the GP and then maybe they’ll begin to get a treatment, or be dead. This wouldn’t be an issue if it weren’t for the fact that this is what happens to every hospital you’ll ever run. It hits a critical mass point where everything suddenly goes wrong and no matter how much you try to do anything, nothing happens. Hundreds of ghosts everywhere, you hire a new janitor who can clean up ghosts, place them right next to the ghost, they walk off to go and empty a bin while everyone screams that there’s a ghost.

Even going to the extreme of forcefully telling half of the 200 patients in the hospital to go and die in their homes doesn’t ever fix this issue, it’s baffling.

We’ve all been there, at hospital, dying of being a clown, when the CEO personally tells you and hundreds others to leave for being too close to death.

Beyond this there’s also the room decoration, it was lovely and wonderful when you started playing, but there comes a point where you hit pure efficiency and everyone gets the same cramped box room, as small a room as you can manage, where the walls are plastered with the same certificate as it provides the most prestige for the smallest space and you begin to wonder what happened to you.

You started out wanting to give healthcare for all, but slowly twisted and turned into a terrible monster focused entirely on efficiency and numbers, these are people’s lives we’re talking about. People who are trapped walking like an Egyptian mummy. People who have a turtle’s head instead of their own human head. People who have suffered the greatest plight of our time, being a clown. To even turn hundreds of people away because they’re close to death already and it’d look bad on your figures if they died in hospital shouldn’t be something you even contemplate, yet there you are, leaving people to die on the streets. Maybe it’s true what they say, you become more heartless the older and more power you get.

Just me, my high tech medical equipment that shoots animals out of you, and my 20 signed photos of the same celebrity. What every health service needs.

Despite all of this, Two Point Hospital is actually quite fun. It is satisfying to slowly work through each hospital and tackle each problem as and when they come and the Two Point radio that plays throughout, filled with quirky, twee and dry radio hosts to satire at you, always manages to come in just when you’re on the verge of mentally exploding from stress.

Two Point Hospital is a solid management game that tries to not take itself too seriously, but also will eventually demand you take it seriously because there are a lot of ghosts running around and all your workers want more money but also everyone is starving to death because you didn’t put down any vending machines. Maybe running a hospital IS hard…