NHS Digital Cloud – esxsi.com

Following on from How VMware is Accelerating NHS Cloud Adoption, this post dives into more detail around how the UK National Health Service (NHS) can use VMware Cloud on AWS to bridge the gap between existing investments and Public Cloud.

Part 1: How VMware is Accelerating NHS Cloud Adoption

Part 2: Bridging the Gap Between NHS and Public Cloud with VMware Cloud on AWS

Example NHS VMware Cloud on AWS Use Cases

Modern Applications: The VMware strategy of late has seen a significant shift towards cloud-agnostic software and the integration of cloud-native application development. VMware Cloud on AWS makes use of the full VMware Software-Defined Data Centre (SDDC) stack; enhancing the security of NHS applications with micro-segmentation, and future-proofing application development with Project Pacific (Understand VMware Tanzu, Pacific, and Kubernetes for VMware Administrators).

Data Centre Expansion or Disaster Recovery: VMware Cloud on AWS can reduce NHS data centre footprint on-premise, by expanding new capacity into VMware Cloud on AWS (Deploy and Configure VMware Cloud on AWS), or through the addition of a Disaster Recovery (DR) site accompanied with VMware Site Recovery Manager (SRM). Legacy Data Centre Evacuation: VMware Cloud on AWS can replace legacy data centres by facilitating the migration of VMware Virtual Machines (VMs) from end of life hardware to VMware Cloud on AWS (Migrate VMware Virtual Machines to VMware Cloud on AWS). In some cases, dependant on internal finance policies, NHS organisations may be able to capitalise the cost of reserved instances (dedicated physical hosts for 1 or 3 years) in VMware Cloud on AWS using recently introduced IFRS 16 Leases. For more information, review the Capitalising Your Cloud Booklet.

Hosting NHS Patient Data: There are several security principles which should be implemented to host patient or sensitive data, further information is available on the NHS Digital website. Important detail on the shared security model of Public Cloud, and other NHS, VMware, and AWS specific links can be found in the How VMware is Accelerating NHS Cloud Adoption article, as well as VMware Cloud on AWS Security One Stop Shop. A summary excerpt is below:

“In January 2018 NHS Digital released guidance for NHS and social care data: off-shoring and the use of public cloud services, along with a toolset for identifying and assessing data risk classification. The NHS and social care data: off-shoring and the use of public cloud services guidance paper published by NHS Digital states; ‘NHS and social care organisations can safely put health and care data, including non-personal data and confidential patient information, into the public cloud’. The 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.”

“Each individual data controller organisation is responsible for implementing and reviewing their own processes around data risk classifications, however to assist NHS Digital have provided a consistent health and social care data risk model. For organisations that do not yet have cloud governance in place NHS Digital have also provided guidance on the health and social care cloud risk framework.

Cloud services introduce a shared security model. NHS organisations can be compliant by implementing a cloud risk framework and proportionate controls outlined by NHS Digital; summarised in the health and social care cloud security one page overview. Security considerations for different

The deployment of any native AWS services should follow best practices outlined in the Security Pillar White Paper of the AWS Well-Architected Framework. VMware Cloud on AWS can make up part of a more comprehensive cloud framework, read more about multi-account and VPC management at Building AWS Environments for VMware Cloud Customers.

Moving to Internet First: As well as the Cloud First strategy outlined in the article referenced above, the UK Government also seeks to make public sector applications, systems, and services accessible over the Internet, with the Internet First strategy. VMware Cloud on AWS can utilise existing on-premise Health and Social Care Network (HSCN) connections, but can also offer the ideal opportunity to move services to Internet-facing. This can be supported with the correct network design, and through making use of native AWS services. There is more information below on how VMware Cloud on AWS complements Internet First, and further reading on the NHS Digital Internet First policy can be found here.

“Health and care services now have an Internet First policy that states new digital services should operate over the internet. Existing services should also be updated to do the same at the earliest opportunity and ideally by March 2021.”

Example Native AWS Service Integrations

In the example architecture below a Stretched Cluster has been deployed across 2 AWS Availability Zones in the London region (eu-west-2), providing VMware Virtual Machine (VM) availability across sites and fault domains. Amazon Direct Connect provides a private link from on-premise networks and should be deployed with resilience, a standby Virtual Private Network (VPN) encrypted connection can also be used. To see these features in action review Watch VMware vSphere HA Recover Virtual Machines Across AWS Availability Zones, and Watch a Failover from Direct Connect to Backup VPN for VMware Cloud on AWS. Optional access to the Health and Social Care Network (HSCN) is provided by the existing on-premise HSCN connection.

Focusing on the VMware Cloud on AWS connectivity into native AWS services from the example architecture, we can note the following:

Connectivity to native AWS services is provided using Elastic Network Interfaces (ENI), a 25Gbps link into Amazon’s backbone network.
Traffic traversing the ENI (ingress and egress) is not chargeable. Any deployed services in AWS are chargeable as usual against the connected AWS account.
Using a Virtual Private Cloud (VPC) Endpoint NHS organisations can make use of additional services such as Simple Storage Services (S3), which offers a tiered approach to object storage and pricing, or Glacier for data archive.
Using the Virtual Private Cloud (VPC) router NHS organisations can make use of services such as Elastic Compute Cloud (EC2), or managed databases with Relational Database Service (RDS).
See AWS Native Services Integration With VMware Cloud on AWS to understand more about VMware Cloud integration with native AWS.

An example scenario could be an on-premise application with a large database which does not have the development resource or funding to refactor for native Public Cloud. It could also be that refactoring this application doesn’t offer any additional business benefit or functionality. In this case, the database could be migrated to RDS, and the front end web/application servers could be migrated ‘as is’ to run on VMware Cloud on AWS. Using the 25Gbps ENI would, in most cases, remove any latency concerns between the application and the database.

It is important to remember that it isn’t only the consumption of traditional infrastructure services that are on offer. Opening up existing workloads to native AWS services drives innovation and modernisation of applications. One example is Amazon’s Artificial Intelligence (AI) powered voice assistant Alexa, which now gives health advice using information from the NHS website. In addition to AI and Machine Learning, AWS has a portfolio of data lakes and analytics services, enabling cost-effective methods for NHS organisations to collect, store, analyse and share data.

In the case of Internet First, VMware Cloud on AWS in conjunction with native AWS, can help scale and consolidate publicly available applications, as documented in VMware Cloud on AWS Reference Architectures. In one such example, the following AWS services are used to facilitate public services hosted in VMware Cloud on AWS:

Amazon Route 53 is a highly available and scalable cloud Domain Name System (DNS) web service for name resolution.
Elastic Load Balancing automatically distributes incoming application traffic across multiple targets. The Application Load Balancer is best suited for load balancing of HTTP and HTTPS traffic operating at the individual request level (Layer 7).
AWS Certificate Manager is a service that lets you easily provision, manage, and deploy public and private SSL/TLS certificates for use with AWS services and your internal connected resources.

Additional optional services for performance and security:

Amazon CloudFront is a fast Content Delivery Network (CDN) service that securely delivers data, videos, applications, and APIs to customers with low latency, high transfer speeds.
AWS Shield is a managed Distributed Denial of Service (DDoS) protection service that safeguards applications running on AWS.
AWS WAF is a Web Application Firewall that helps protect your web applications from common web exploits that could affect application availability or compromise security.
AWS CloudTrail is a service that enables governance, compliance, operational auditing, and risk auditing of your AWS account.

This post provides an overview of how the UK National Health Service (NHS) can unlock the benefits of cloud computing with VMware Cloud (VMC) on Amazon Web Services (AWS).

Part 1: How VMware is Accelerating NHS Cloud Adoption

Part 2: Bridging the Gap Between NHS and Public Cloud with VMware Cloud on AWS

In November 2014 the National Information Board and Department of Health and Social Care published the Personalised Health 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 digital cloud services, backing 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 a toolset for identifying and assessing data risk classification. The NHS and social care data: off-shoring and the use of public cloud services guidance paper published by NHS Digital states; ‘NHS and social care organisations can safely put health and care data, including non-personal data and confidential patient information, into the public cloud’. The 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.

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 trusts and other organisations to migrate workloads and extend their on-premise infrastructure. Steps for understanding the data type, assessing migration risks, and implementing and monitoring data protection controls are also included in the documentation linked above. Each individual data controller organisation is responsible for implementing and reviewing their own processes around data risk classifications, however to assist NHS Digital have provided a consistent health and social care data risk model. For organisations that do not yet have cloud governance in place NHS Digital have also provided guidance on the health and social care cloud risk framework.

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. Micro-segmentation is included for all virtual machines in the default VMware on AWS pricing model.
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 at: VMware Cloud on AWS Security One Stop Shop

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, such as favourable VMware on AWS pricing, 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.

Existing VMware Virtual Machines (VMs) 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 physical host or per number of VMs organisations can adopt a Bring Your Own Licensing (BYOL) approach.

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.

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.
Full details can be found at AWS Native Services Integration With VMware Cloud on AWS

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.