Two Point Hospital (PS4) Review

Bullfrog Productions were one of my favourite developers when I was a kid, they turned me onto simulation and management games, genres which I’m a massive fan of to this day. Whether I was a Dungeon Keeper setting traps for the pesky ‘heroes’, Managing my own Theme Park, or dying of laughter within my very own Theme Hospital, every game was engaging, strategic, and very fun to play. Two Point Hospital is a spiritual successor to the renowned Theme Hospital, developed by Two Point Studios which contains many of the original developers from Bullfrog Productions!

After getting my hands on the game back in 2018, on Steam, and reviewing it, the game has had a number of updates and new features added, making the game much more immersive and fun to play than it was at launch. However, not every feature and function has found it’s way to the console version (yet), some are coming in March 2020 and some have no date or confirmation regarding their inclusion. As I’m taking a look at the PS4 version today, I’ll be sure to let you know what isn’t here and roughly when certain parts of the game are set to be added (for free).

So, pray for your life as you enter the pee and poop contaminated hallways of Two Point Hospital

Two Point Hospital 1

This is an example of a poorly designed hospital…

You are the new director of Two Point Hospital, you’ve been hired to help rebuild what little reputation the company has by renovating and rebuilding entire hospitals from scratch within a variety of locations. However, although the task of creating the NHS 2.0 sounds super-easy, it really isn’t, it’s pretty damn hard and stressful. Not only do you have to plan out your rooms so that they all fit within the small allocated spaces, but you must also hire and train the best people for the job. Not only that, but you must also think about your patient’s needs if you wish to make everyone happy.

If you’ve ever played the original classic management sims I mentioned above, or maybe even modern games such as Planet Coaster, Jurassic Park: Evolution, Tropico 6, or even Dungeons III, then you’ll feel right at home with Two Point Hospital. It’s all about expanding and advancing whilst also maintaining your incoming and outgoing resources and expenses until you reach a profitable balance. However, I’ve put in at least 30 hours on this console version so far and I can honestly say that the game isn’t going to be a walk in the park – the game gets really, really hard if you stick to a single mindset and jump the gun on what you want to build without adapting to the scenario. 


Alongside Tropico 6, I can safely say that this is one of the most addictive and fun management simulation games I’ve played for a long time. Also, although not technically having a ‘story’ as such, the console release contains two DLC packs which drastically changes both the setting and the gameplay whilst presenting you with their own ‘story’ for you to play through. 

Two Point Hospital 2

Cloning the rooms makes designing much easier and faster.

The developers have done an amazing job of taking a game that was clearly created to be played with a mouse and keyboard and adapting it to the controller perfectly. This means that Mouse and Keyboard support isn’t within the game (I’ve just checked), so thankfully, the control scheme is very innovative and well-mapped. So, despite the game being very heavy on micro-managing, and gets really involved the further into the game you get, you never feel like you don’t know what button to press or where the info is which you need to do your job.

PSA: Rooms don’t have to be a rectangle – something I didn’t actually realise when I first reviewed the game. You can create whatever size and shape you want as long as it’s at least the minimum size to fit in the mandatory room items. Whereas a few items are unlocked for use at first, you can enhance the experience for your tiny employees by spending your ‘Kudosh Points’ and unlocking new and exciting items such as the Golden Toilet or SEGA Arcade Cabinets. As with everything within Two Point Hospital, you could create a very ‘meh’ hospital by only paying for the bare essentials the room requires, or you can totally pimp out each and every room to make everyone happy whilst working the long hours you force them to do.

The console edition includes the best post-launch PC update, an update that changes everything! It’s called ‘Copy and Paste’ and it’s the best thing since sliced bread! Okay, so the concept isn’t original but the fact you can literally ‘Copy’ any room you’ve created, then ‘Paste’ it anywhere is one of the best features the game could have ever added. It means you can create a single GP’s office with the perfect layout, balance of items, random objects that make the mini-workers happy, and lots of clown posters, then simply clone it over, and over again. 

Two Point Hospital 3

Don’t mind the furry literally ‘begging for attention’ on the floor!

Are you okay?
As I explained within my PC review, the illnesses you’ll find within Two Point Hospital are on the same level as the crazy and silly symptoms we saw back in Theme Hospital many years ago. You have people suffering from ‘Lightheadedness’ who literally have a light bulb for their head, ‘Denim Genes’ results in people having denim for skin, ‘Turtle Head’ makes them look like Toad in the Super Marios Bros Movie, and if there’s a ‘Pandemic’, everyone has a pan on their head. The entire list of illnesses and diseases are basically puns that are visually represented perfectly – some of which even have humous machinery to cure them.

Unfortunately, your GP’s aren’t going to figure out the actual illness a person is suffering from on their own – something which perfectly mirrors real life. Instead, you’ll have to build a number of diagnostic rooms such as Cardio, X-Ray, The DNA Room, The Injector, and more. Then you can watch as the dying patients are passed from pillar to post as they see the GP, go get examined, return to the GP, go to another test, return to the GP, finally make their way to get cured, then die and turn into a ghost because they’ve spent almost a whole year walking the corridors of the hospital – no wonder hospitals are always crowded!

However, once you have a smooth-running hospital and you’ve monitored the demand so that you can create the rooms people use the most to ease traffic, that’s when you can start to experiment. Two rooms which I’ve not really used up until the purpose of this review are the Research and Marketing room. Marketing is as you’d expect, you can create campaigns to bring in more people for a specific illness/room, look for staff to hire with certain talents, or just generally promote the hospital. Research is the Holy Grail – you can work on a bunch of new rooms, upgrades, or misc boosts, all of which remain unlocked forever. So, if you get stuck and can’t find the time to research on a level, simply reload a hospital you’ve completed, set up a room, and research forever.

Two Point Hospital 4

Feels like I’m back in school!

Only as good as your staff
I know I keep saying this but I don’t believe I invested enough time into the PC version of Two Point Hospital as I’ve learnt so much more about how to properly maintain and run all of the various locations over the last week. One such mechanic which I wasn’t utilising correctly is the training of my staff. Most locations will allow you to hire staff at various points in their career, so some will have no extra skills yet others may have additional boosts in diagnosing or catching ghosts (yeah, that’s a thing). But, some are brutal and only let you hire n00bs who have zero skills, requiring you to train them all and build up their personal abilities. 


So, once you’ve got a training room, you can either use your own staff to teach others a skill they know or pay for someone to train your staff for you. It takes a while to fully get to grips with it all but once you have, it makes the whole experience and management side a lot deeper and more involved. 

However, you can’t rely on stats and figures in order to keep your hospital maintained as you have to remember that all the small employees are people, people with feelings and weak bladders. I can’t count how many times people have quit because they need to pee or they need a drink and refuse to use the water fountain within the hospital – would you use a water fountain in a hospital? As such, you need to ensure that the needs are met for both the paying guineapigs patients as well as your employed workforce. This is quite difficult at times because even if you place a toilet right next to them, they’ll still say they need the toilet and can’t find one – strange.

One thing I really liked – which I think is on the PC version but I never really explored before (surprise, surprise) is the customisation options. Sure, you can’t fully customise your staff uniforms (something I really wish we could do), but you can use your Kudosh Points to unlock new designs such as a high-vis getup for the janitors.

Two Point Hospital 5

I have the best hospital in the world, we have golden toilets!

Three-star treatment
Each location has three stars which can be achieved based upon set challenges for you to complete. The first star is supposed to be easy, and it is in earlier stages, but it takes a very long time to achieve in later levels. Your given three or more objectives to meet, all of which need to be achieved at the same time – so if one of them is to have a 70% success rate on the last 20 patients you ‘cured’, and another is to have a hospital worth a million dollars, you need to ensure both of them are met without falling below their threshold in the interim. 


One star is all it needs to either unlock new locations on the map or at least count towards unlocking the next location (as some require you to complete a few locations first). Stars two and three are there for you to strive for if you wish to, and if you’re going for the platinum, but they aren’t essential in terms of progressing throughout the map. 

As well as the stars, there are a bunch of mini in-game achievements for you to unlock. Some are mirrored with the actual PSN trophies, such as training people to be level five in their profession, but most of them are separate and act as a way to quickly unlock more Kudosh Points. These allow you to gain more points by simply playing the game and watching as they naturally hit their goal. 

Two Point Hospital 6

The Bigfoot DLC gets quite manic very quickly!

DLC included
There are two DLC packs included within the base game of Two Point Hospital on consoles, Bigfoot and Pebberley Island. I initially thought these may be post-launch downloads as I couldn’t find them within the game at all, but then I realised you had to complete all of the locations on the starting island first. Both of these expansions offer a much greater challenge to the game as they bring in new mechanics and issues to worry about, this is briefly what they are:

Bigfoot: This pack takes you into a snow-based island that is very cold and requires you to ensure the heat is always on. It brings with it a bunch of new items, such as a Christmas tree and wreath (although they’re not called that). There are also 34 new illnesses, of which 9 are visual illnesses with their own pun-tastic names and funny designs. Also, there are a few new rooms for diagnosing and curing these issues such as the Kennel for curing the Barking Mad furries! The big gameplay change here is, you’re not paid by people when you cure them, you get a bonus for completing challenges – so it’s like the NHS.

Pebberley Island: Think of the opposite of Bigfoot – that’s what this is. You’re now on a desert-like island where water is scarce and the heat burns. So, instead of keeping people warm, you have to bring in the air conditioners and ice sculptures in order to cool everyone down! This pack also has 34 new illnesses with 10 of them being visual ones, plus new rooms character models. I’ll be honest here, I’ve not made it past the first location within this pack yet as it’s much harder than the base game and Bigfoot – a nice challenge for those who like pain.


Both Packs contain three islands.

Unfortunately, the ‘Close Encounters’ DLC pack isn’t included, neither is the ‘Retro Items Pack’ from what I could see. I imagine these will become available at some point in the future though as they were the last two packs released on the Steam version in August last year. 

Two Point Hospital 7

Complete in-game challenges and earn extra rewards.

Missing things!
First, the things I noticed which were missing with no info on why or if they’re coming later:
• No custom designs. In the Steam version you can import pictures and turn them into posters, rugs, wallpaper and carpets – the console version doesn’t support this (which is a shame).
• No Steam workshop. Obviously, there’s no support for the workshop, but it would have been nice if a selection of the best creations were included, or some sort of alternative on consoles so we can fully personalise our hospitals.
• No simple co-op as we saw on launch with the Steam version. When Two Point Hospital originally launched it had the option to participate in simple challenges with your friends, such as ‘cure X amount of patients the fastest’ or ‘the player with the most research points after X minutes wins’. This function isn’t on the console edition.

The above aren’t major omissions but the following two are quite big features which people really enjoy on PC. Thankfully, the below are both being added into all console versions by the end of March 2020 (if all goes well). So, although no there on launch tomorrow, they are coming soon – for FREE.

• Sandbox: Freeplay Mode. As of launch, the game only has the mission-based levels where you are trying to meet certain objectives in order to progress. However, once you’re beaten the first three locations, Freeplay will let you create sandbox hospitals in any of the fifteen locations within the game (maybe more if the DLC hospitals are included). You can enable or disable a wide array of things such as giving yourself unlimited cash and Kudosh as well as changing the parameters on what’ll happen within your hospital. I’m not sure if this mode will disable trophies though as if it doesn’t, it’ll be quite easy to obtain otherwise grindy ones. 


• The Superbug Initiative. I’m not too familiar with this but it seems like a much more engaging multiplayer mode where you and your friends can all work together to achieve set goals. Judging by the promotional video HERE, it’s not the mode I saw which launched with the game back in 2018, it seems much bigger and more advanced. It’ll be interesting to try this mode out and also to see if it requires you to have a PS Plus account as it’s merely collecting everyone’s stats by the looks of it – you’re not actually playing together. Games that do that don’t usually require PS Plus – like Death Stranding. 

Two Point Hospital 8

The PS4 Pro issue

Bugs and Issues
I felt like this needed its own section as Two Point Hospital isn’t perfect – not yet anyway. I’ve been quite lucky as the game has only crashed once on me during the entire 30+ hours I’ve played it so far. However, I’ve heard the developers are still ironing out a few bugs here and there which could cause crashes in certain instances – so, save regularly and ensure you update the game if you buy it physically. 

Now, there is one actual bug that I’ve reported that isn’t going to be fixed until the March update (when the above features are being added) – the lighting issue. If you’re playing the game on a PS4 Pro and you either have Supersampling turned on or you’re playing on a 4k TV, the game will appear quite dark as if someone has turned the hospital lights out. But, if you adjust the camera so that it’s almost top-down, the lights all come on and it appears much brighter (there’s an image comparison above). 

The fix for this bug (until the patch is released) is to disable supersampling and/or change the output to 1080p. If you’re outputting at 1080p or playing on the base PS4, the lights are consistently on and everything looks as it should (although I still believe it’s a little darker than the PC version based on my screenshots from my previous PC review).


Also, we were advised that “the long loading and saving times will be reduced by launch”. I’ve been playing it for around a week and we’ve had a few updates within that time – I can safely say that there are no time issues at all, even though some sites seem to have made out like there is. On the PS4 and the Pro (I’ve tried both), saving takes about 5 seconds and the game itself took about 10-15 seconds to boot up after the developer cards. In terms of loading – if you’re starting a new hospital then it’s about 5-10 seconds and loading a previous build is up to 40 seconds based on the size and complexity. 

I don’t know about you, but that’s not really a long loading time. Once the level is on, that’s it – no loading until you move on to the next one. Other than the above though, the game ran great on both the PS4 and the PS4 Pro, even with lots of action going on – it was very smooth with no obvious frame drops or performance issues. 

Two Point Hospital 9

I don’t think my employees will be late off their break again…

Music and visuals
The music is the same as on PC, it’s very calm, relaxing, and muzak-like. I always find it quite amusing watching my hospital burn to the ground with people screaming whilst jolly music plays in the background. You can create your own in-game setlist, set the audio to play in sequence, or shuffle. The only thing I wish you could do is put in your own music, like on PC, but you can technically do that by muting the music and putting your own MP3 files on a USB drive or loading up Spotify. 

The announcers also deserve a mention as the witty banter they come out with is hilarious at times. They’re so emotionless and straight to the point about all the destruction and death happening all around you.


The visuals are brilliant, a clear homage to the original Theme Hospital but with a modern style to make them look very cartoony to balance out the ‘serious’ side of the game. My one request – I wish there was a photo mode and/or a way we could zoom right in and walk around the actual hospital as you can do in Megaquarium. Sure, that game is about an aquarium and not a hospital, but I love it when you can wander around your own creations – I believe the original Theme Hospital (or one of its sequels) let you do it as well. 

The reason I want to see things up close is that at the moment, the closest zoom just isn’t close enough – you can make out that the characters and objects are highly detailed, but you can’t appreciate it due to how far back the closest camera zoom is.

Official Trailer:

Final Conclusion:
Two Point Hospital is a very satisfying and rewarding management simulation game, something we need more of on consoles. Whether you’re pulling off peoples heads in order to replace them with a fleshy alternative, or managing your team of top doctors via training and providing them more clown posters to look at, there’s always something to do. There is a steep learning curve once you’ve completed the second island, but patience and dedication pay off as the greater the challenge, the greater the satisfaction when you hit three-stars! If you have any interest in resource management, simulation, or strategic games, you need to buy Two Point Hospital – it’s that good.

Despite the fact that two big features aren’t live at launch, they’re coming within the next month as a free update so it gives you plenty of time to learn the basics first. There are a few smaller features on PC that never made the cut for the console version but I honestly didn’t miss them when I was playing it on my PS4.


A copy of the game was kindly provided for review purposes

Two Point Hospital


Final Score


The Good:

  • - Very addictive gameplay
  • - Visually it looks amazing and has no performance issues on either the base PS4 or the PS4 Pro
  • - Very challenging yet very rewarding and satisfying too
  • - Very nostalgic to games like Theme Hospital (same devs)
  • - Contains two DLC packs for even more gameplay

The Bad:

  • - There is an issue with the PS4 Pro in 4k or Supersampling mode at the moment. Not affected the score as should be fixed soon
  • - No Sandbox or Superbug Initiative at launch. Again, not affecting the score but these won't be out until the end of March 2020
  • - The game does get hard, very hard, once you've past the first island. Some people may get intimidated and put off by this (my advice, go slow and take your time)
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