Why ‘Theme Hospital’ is the greatest of the simulation satires

Putting someone with zero medical experience in charge of high-stakes healthcare contracts worth millions… sounds familiar, doesn’t it?

On paper at least, Theme Hospital feels like the most dreary concept imaginable. Surely games should be about escapism, not filling in endless patient risk assessments while a middle-manager called Sandra honks her coffee-breath down your neck? Given the choice between shooting at mutant aliens with a laser bazooka or running an efficient healthcare system in a business simulation game, you’d expect the space-adventuring to win out every single time. And yet, instead, I spent an unhealthy proportion of my childhood moving potted plants around waiting rooms, hiring and firing doctors with Alan Sugar levels of abandon, and monitoring the flow of little pixelated blobs through my lovingly constructed triage system.

As a kid, I was too much of a gigantic wimp to play games with feral zombies and rabid wolves. Instead, I was obsessed with anything that mimicked real life. I’d spend hours shooting fictional feature films on studio management game The Movies, and painstakingly crafting death-defying rides for RollerCoaster Tycoon. Ruling over entire metropolises on SimCity gave me a giddying God complex, and tinkering to find the ideal recipe on Lemonade Stand was weirdly meditative. And out of the whole lot, Theme Hospital was the pinnacle – the perfect blend of dark humour and sheer silliness.

Initially, the goal of Theme Hospital is simple enough – players buy chairs for waiting rooms, hire a competent medical team, and build enough facilities to cure the local community of fictional ailments such as bloaty head, the uncommon cold, broken wind, and King Complex (a narcissistic condition which causes people to impersonate Elvis Presley). At first, there’s something incredibly fulfilling about hovering your benevolent cursor over high-priority admissions and whisking them to the front of the queue, and conducting vital research into curing more complicated diseases like The Squits; the whole hospital operating like a satisfyingly well-oiled machine.

To this day, I find it impossible to set foot in a hospital without wanting to plonk an extra bunch of houseplants next to the pharmacy, or longing for a nearby KitKat vending machine. A few years ago, after smashing my wrist to pieces in a ‘snowboarding accident’ (I had a board strapped to my foot at the time, so it counts even though I was technically standing still), I found myself feeling incredibly displeased by the A&E’s puzzling seat arrangements. Maybe it was the copious amount of painkillers in my system, but – for a fleeting second – I felt like I could improve the building’s ergonomic flow if only somebody would take a chance on me. And look, I’m under no illusions; everyone can agree it would be completely catastrophic if I was placed in charge of a medical facility. But playing Theme Hospital, I felt like I could run one anyway, if only I really wanted to.

Theme Hospital. Credit: EA
Theme Hospital. Credit: EA

As you rise up the star ranks of hospital management, however, this cutesy-looking game takes a dark and satirical turn. Slowly but surely, Theme Hospital starts encouraging petty acts of financially-motivated evil – like turning the heating down a few degrees to keep staff working harder, or installing a fizzy drinks vending machine instead of giving patients free drinking water. With your hospital’s reputation constantly at stake, the temptations become more insidious. As patients start defecting to a rival institution, and the coffers quickly start to dry up, why not bribe the local authorities to cover up the recent epidemic that left your corridors coated with cartoon vomit? If patient death numbers are causing your league table position to plummet, why not chuck the really sick ones out before they get the chance to croak it on your property, or better still, sacrifice their lives to the automatic autopsy machine to advance the latest in medical research?

Created by the UK video game developer Bullfrog Productions in the mid-‘90s, the original plan for Theme Hospital was rooted in reality – the idea was that players would treat real-life diseases. Based in Guildford, Bullfrog’s offices were coincidentally next door to the Royal Surrey County Hospital, but when developers visited it for inspiration, they quickly realised that the highly functional, mint-green interiors of hospitals, and the grisly reality of treating life-threatening diseases felt too grim for a game.

On a later research trip to another hospital called Frimley Park, developers Mark Webley and Gary Carr watched a spinal operation through their hands, and once they’d been offered a tour around the morgue, they knew that a cartoonish hospital with joke illnesses was the way to go. Rather than staying true to the actual process, Theme Hospital is built around people’s assumptions – most people’s first appointment at the game’s hospital is with a GP. “The important thing with games like Theme Hospital and Theme Park is that it is not about how a hospital, theme park, or a business runs,” Webley told GamesRadar. “It is about how people think they are run.”

Theme Hospital. Credit: EA
Theme Hospital. Credit: EA

When it came to the game’s business element, Bullfrog steered clear of NHS-style government funding and built gameplay mechanics around a US-style healthcare system where patients pay for treatment. As players take over hospitals in different areas, certain things become apparent; in wealthy neighbourhoods patients will still cough up if you bump up the treatment costs, facilities will improve and investors will stay happy. Where there’s less room to hike up the prices, patients get crappy treatment, and when experienced doctors start complaining about low wages it’s less hassle to swiftly give them the boot before hiring another junior underling.

Though many of the game’s most pressing concerns (like piling thousands of pounds into baldness research) feel ridiculous, it still chimes with real life, and swiftly, Theme Hospital turns even the most devout fan of ‘Clap for Carers’ into a profiteering overlord hellbent on monetising every last aspect of healthcare. It seems obvious now, but back then, I didn’t realise that Theme Hospital hid a more serious message – as well as the perfect cautionary tale against teenagers running hospitals it was also a satire built around the dangers of healthcare privatisation.

Theme Hospital. Credit: EA
Theme Hospital. Credit: EA

And ultimately, this is why I consider Theme Hospital a sick, twisted work of genius that inadvertently advances the cause of socialism just by presenting the opposite. Similarly to The Sims – which seems like a harmless game at surface level, but turns its players into arson-loving Sim murderers within seconds – Theme Hospital’s sadistic streak is ultimately what makes it a classic.

El Hunt is a staff writer at NME. You can read the rest of the Remastered column here.

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