This post provides an overview of how the UK National Health Service (NHS) can benefit from VMware Cloud (VMC) on Amazon Web Services (AWS).
In November 2014 the National Information Board and Department of Heatlh and Social Care published the Personalised Health and Care 2020 paper, outlining a framework to support the NHS with making better use of data and technology to improve health and care services. The paper endorsed the use of cloud services, backing up the UK Government cloud first strategy, introduced in 2013.
In January 2018 NHS Digital released guidance for NHS and social care data: off-shoring and the use of public cloud services, along with tools for identifying and assessing data risk classification, and a cloud security one page overview. The paper states that ‘NHS and social care organisations can safely put health and care data, including non-personal data and confidential patient information, into the public cloud’. NHS and Social care providers may use cloud computing services for NHS data, providing it is hosted in the UK, or European Economic Area (EEA), or in the US where covered by Privacy Shield. Steps for understanding the data type, assessing migration risks, and implementing and monitoring data protection controls are also included in the documentation.
The Information Governance (IG) report for Amazon Web Services was updated in 2018, the score approves Amazon Web Services to host and process NHS patient data. VMware Cloud on AWS leverages Amazon’s infrastructure to provide an integrated cloud offering, delivering a highly scaleable and secure solution for NHS organisations to migrate workloads and extend their on-premise infrastructure.
The NHS can implement Secure by Design services with VMware Cloud on AWS
- NHS organisations must be aware of the shared security model that exists between: VMware; delivering the service, Amazon Web Services (the IaaS provider); delivering the underlying infrastructure, and customers; consuming the service.
- The NHS organisation is in complete control of the location of its data. VMware do not backup or archive customer data and therefore it is up to the NHS organisation to implement this functionality.
- Micro-segmentation can be used to protect applications by ring-fencing virtual machines in a zero trust architecture. The risks of legacy operating systems can be mitigated by isolating them from the rest of the network.
- NHS organisations can use Role Based Access Control (RBAC) and Multi-Factor Authentication (MFA) to control access to cloud resources. NHS organisations are in control of inbound and outbound firewall rules and can opt to route all traffic internally on private addressing.
- VMware Cloud on AWS meets a number of security standards such as NIST, ISO, and CIS. Standard Amazon policies for physical security and secure disposal apply. Amazon use self-encrypting disks and manage the keys using Amazon Key Management Service (KMS).
- VMware implement a number of stringent security controls, for example MFA generated time-based credentials for support staff; all logged and monitored by a Security Operations Centre (SOC), VSAN based encryption, and industry-leading commercial solutions to secure, store, and control access to tokens, secrets, passwords, etc. Full details can be found in the VMware Cloud Services on AWS Security Overview.
Additional benefits of VMware Cloud on AWS to the wider NHS, are as follows:
The NHS can save time and money by reducing physical or data centre footprint
- NHS Digital reached an agreement in May 2019 to offer other NHS organisations discounted access to cloud services to help accelerate their journey to the cloud. In addition, a favourable pricing structure is in place for reserved instances should organisations commit for 1 or 3 years.
- Commissioning new space in a data centre, or even just new hardware, can be a lengthy process. With VMware Cloud an entire virtual data centre can be deployed in around 90 minutes. Extending capacity on demand takes as little as 15 minutes.
The NHS can protect existing investments and move to the cloud
- Existing VMware workloads can be migrated to VMware Cloud on AWS, and back if needed, in minutes without the need to refactor applications.
- NHS technical staff continue to use the same tools and management capabilities that they currently use day to day.
- In most cases where products such as Monitoring, Backups, and Anti-Virus, are licensed per host or per number of Virtual Machines (VMs) organisations can adopt a Bring Your Own Licensing (BYOL) approach.
The NHS can improve service performance and availability
- VSAN replication and stretched networks can enhance Disaster Recover (DR) capabilities. The Stretched-Cluster deployment provides vSphere High Availability (HA) across 2 Amazon Availability Zones within a region with a 99.99% availability commitment. Additional DR services such as Site Recovery Manager (SRM) add-ons are also available.
- In many cases replacing aging servers and storage infrastructure with the latest hardware and flash based VSAN can yield significant application performance benefits.
- Physical host capacity can be scaled out dynamically and then back in when it is no longer required. NHS organisations can take advantage of easily spinning up environments to test or develop without having to manually install and configure additional hardware.
The NHS has private access to native AWS services
- VMware Cloud on AWS has a private link into Amazon’s backbone network of services, ranging from storage, database, and network services, to Internet of Things (IoT), Artificial Intelligence (AI) and Machine Learning. Developers can take advantage of various managed container services, or serverless platforms.
- Since VMware Cloud resides in Amazon’s data centres hybrid configurations can be securely implemented, for example using Amazon’s Elastic Load Balancer with the back end servers in VMC, or Amazon’s Relational Database Service with the application servers in VMC.
NHS technical staff will have more time to proactively make improvements to systems and processes
- Hardware maintenance such as firmware updates, failure remediation, and upgrades are all handled by VMware, as are software updates to the hypervisor and infrastructure management layer.
- NHS technical staff are responsible for securing applications inside the virtual machine, e.g. operating system updates and firewall configuration, ensuring that Amazon Secure by Design best practises are followed.
In summary VMware Cloud on AWS enables NHS organisations to seamlessly extend or migrate data centre workloads to the cloud, whilst enhancing security and availability options. In the example shown below an existing VMware vSphere environment has been extended to VMware Cloud on AWS, giving organisations the flexibility to run their workloads on the most suited platform. This approach is secure and easy for operational teams who may not yet have an established cloud governance process in place.
Additional notes on this design: The Internet Gateway for VMC is not in use, all routes are advertised internally and controlled using on-premise firewalls, in other words all ingress and egress traffic is via the on-premise data centres. Access to native AWS services uses the 25Gbps Elastic Network Interfaces (ENI) and is secured using the gateway firewall and Amazon Security Groups.