Hailing from England – the land of tea obsession, driving on the wrong side of the road and Noel Edmonds – I’m used to a little organisation called the National Health Service. When I caught chicken pox, needed vaccinations and wound up with wonky teeth, a centrally-run service built on taxpayer money would dole out my lollipops, my brave-girl stickers and banana-flavoured ear medicine. Telling little Charlotte that in other countries, healthcare is big business, would have been like telling me the tooth fairy didn’t exist, or that I would never meet the Spice Girls. Being well was just something that happened, not something that was painstakingly managed. That illusion was shattered when I picked up Theme Hospital (the PS1 version) as a 6 year old in 1998.
Released by Bullfrog (the same team behind Dungeon Keeper and the game’s spiritual predecessor, Theme Park), Theme Hospital does exactly what it crudely says on the tin: it is a hospital management simulator. The main aim of the game is to progress through different buildings, transforming them into successful hospitals and meeting predetermined goals, in order to be granted the opportunity to create bigger hospitals. These goals will become increasingly difficult, to the point of being quite punishing. If you get to the end of a fiscal year without so much as two pennies to rub together and the health inspector is fishing rats out of his trouser legs, it’s Game Over.
As a 6 year old who barely knew how to do her times-tables, never mind achieve a secure grasp on microeconomics, the game was hard as nails. I mainly contented myself with watching my aunty work out all the sums and the management decisions, while I just tittered away at typhus-ridden patients chunking up the corridors. However, EA’s rival to Steam, Origin, gave me the opportunity to experience the game once more as an adult; in January 2015, the game became free to all Origin users. It is still free on the German Origin store; this may vary from country to country, but you should be able to pick up the standard version pretty cheaply for computer or PS1 regardless. It’s also available on the Playstation Store in Europe for 5 euros and for similar prices in the NA Store.
So, how did my experience of playing Theme Hospital shape up, 17 years after my initial taster? For starters, don’t be fooled by the Origin price tag – the game is most certainly not shovelware. It’s a highly entertaining yet tough strategy game, which I would recommend to pretty much anyone interested in the strategy genre.
By far the best characteristic of the game is its wit. The opening cut-scene perfectly showcases the game’s black sense of humour, and just so happens to be one of the funniest game-openers I’ve ever seen (with the original Theme Park‘s opening cut-scene coming a close second). In the golden age of Bullfrog, the games they were putting out were laugh-out-loud funny. It also has plenty for Bullfrog fanboys and girls to salivate over, with cameos from characters out of the Dungeon Keeper franchise – keep your eyes peeled while watching the video below.
I burst out laughing at 0:52 every. Single. Time.
The black humour continues throughout the gameplay, sneaking its way into every little detail, including descriptions about staff members’ competencies, the illnesses that people turn up at your hospital with and the end-of-year leader-boards. To give you another window into just how funny this game is, the video below shows some of the background dialogue that is sprinkled through the gameplay, this being conveyed through the hospital tannoy system.
Regarding actual gameplay, the level of detail to which your decision-making descends is very fine, particularly to say that the game was released in 1997. Something as simple as not installing enough vending machines can lower the morale of your patients, causing them to walk out. This can result in a Game Over on levels where a key objective is to treat a certain number of patients, and given that one level can take approaching an hour to complete, these simple mistakes can be time-consuming. Furthermore, you will be faced with the regular choice between hiring cheaper but less competent staff, or investing in the brightest bunch available and potentially running out of money/having to run to the bank manager with your tail between your legs.
This decision is particularly important, since disgruntled staff who are either unskilled or treated poorly may hand you an ultimatum: give them a pay rise or they’ll resign. A staff training mechanic becomes available in later levels, with doctors being able to specialise. Having a much-valued psychiatric specialist threaten to waltz off to the Bahamas for an early retirement unless you give him a backhander can be a pain in the bum to say the least, so you quickly learn to force your staff to take breaks in a plush staff room (complete with snooker table…very fancy!).
As with Theme Park, the scope for unlockables is largely self-determined, through your own ability to build a research laboratory and then plunge varying amounts of money into researching new cures/machines. As the different fields of medicine that are available increase, so does the cost of building each room dedicated to treating a particular illness or set of illnesses. As a result, I (at least) found that money can become quite scarce as the game progresses, and you will find yourself doing some penny-pinching towards the end.
However, the game is clearly not just about money, but also about saving lives – at least from a targets point of view. A certain amount of deaths on your doctors’ watch will lead to a Game Over, and passing many levels requires a particular standard of patient satisfaction and a certain number of patients treated. This can become nail-biting when there is an epidemic of a particular illness for which you only have 1 or 2 assigned doctors/rooms, resulting in the queue of patients almost snaking out of the door. The game also does not shy away from toilet humour; if there’s an outbreak of the Squits in your hospital, my thoughts are with you during this difficult time. I sure hope you thought in advance to build enough toilet cubicles.
As well as factors that will affect your performance over a longer period of time, there are also random events that can be to your benefit or to your detriment. Visits from the health inspector can be rather lucrative, as long as you have a fairly decent janitor and zap any pesky vermin with your computer mouse (yes, as well as being an omniscient, omnipresent healthcare svengali, you are also Rentokil in this game). There are also events in which you receive a bonus if you treat a certain set of patients within a very short period of time. If the treatment involves something as demanding as surgery (which requires two specially-trained doctors and a nurse), you may find yourself barking orders at the screen while you try to cajole the relevant healthcare professionals into staying in the operating theatre.
If I did have a couple of criticisms to throw at the game, they would largely be related to the previous point: the AI is a bit thick. Doctors’ morale drops perhaps a bit too quickly, and it can become quite tiresome dragging them around the map to avoid patient walk-outs. Furthermore, you will find yourself hiring the worst of the worst staff available towards the end of the game, not just due to dwindling funds but also because you run out of staff on the roster to hire. The lack of space available for some of the larger treatment rooms can become very annoying, especially when precious few patients seem to require that specialty – this is the case even before you get to Battenburg, Management Hell on Earth (the final level). However, this is perhaps less of a criticism and more of a pointer as to how you will improve beyond your first playthrough: you will eventually learn which rooms it is worth building in abundance, and which can wait until you progress further through the game.
Overall, the game is a bit of an oddball in terms of both its humour and content, but you will quickly fall in love with its quirky charm and disgusting visuals/sound effects. It’s well worth wasting a few hours on a Sunday afternoon playing through the opening levels. I wouldn’t say it is my favourite of the Theme games, but it’s a very close second. As for which is my favourite? You’ll have to wait until the next blog – it may be slightly controversial…