How VMware is Accelerating NHS Cloud Adoption

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.

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 data classifications are detailed in the health and social care cloud security – good practice guide.

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.


VMware Cloud on AWS FAQs | Resources | Documentation | Factbook | Evaluation Guide | On-Boarding Handbook | Operating Principles

Watch VMware vSphere HA Recover Virtual Machines Across AWS Availability Zones

This post demonstrates a simulated failure of an Availability Zone (AZ), in a VMware Cloud on AWS stretched cluster. The environment consists of a 6 host stretched cluster in the eu-west-2 (London) region, across Availability Zones eu-west-2a and eu-west-2b.

The simulation was carried out by the VMware Cloud on AWS back-end support team, to help with gathering evidence of AZ resilience. Failover works using vSphere High Availability (HA), in the event of a host failure HA traditionally brings virtual machines online on available hosts in the same cluster. In this scenario when the 3 hosts in AZ eu-west-2a are lost, vSphere HA automatically brings virtual machines online on the remaining 3 hosts in AZ eu-west-2b. High Availability across Availability Zones is facilitated using stretched networks (NSX-T) and storage replication (vSAN).

AWS Terminology: Each Region is a separate geographic area. Each Region has multiple, isolated locations known as Availability Zones. Each Region is completely independent. Each Availability Zone is isolated, but the Availability Zones in a Region are connected through low-latency links. An Availability Zone can be a single data centre or data centre campus.


You may also want to review further reading: How to Deploy and Configure VMware Cloud on AWS (Part 1), How to Migrate VMware Virtual Machines to VMware Cloud on AWS (Part 2), plus additional demo post Watch a Failover from Direct Connect to Backup VPN for VMware Cloud on AWS. For more information on Stretched Clusters for VMware Cloud on AWS see Overview and Documentation, as well as the following:

VMware FAQ | AWS FAQ | Roadmap | Product Documentation | Technical Overview | VMware Product Page | AWS Product Page | Try first @ VMware Cloud on AWS – Getting Started Hands-on Lab

Availability Zone (AZ) Outage

Before beginning it is worth re-iterating that the following screenshots do not represent a process, the customer / consumer of the service does not need to intervene unless a specific DR strategy has been put in place. In the event of a real world outage everything highlighted below happens automatically and is managed and monitored by VMware. You will of course want to be aware of what is happening on the platform hosting your virtual machines and that is why this post will give you a feel of what to expect, it may seem a little underwhelming as it does just look like a normal vSphere HA failover.

When we start out in this particular environment the vCenter Server and NSX Manager appliances are located in AZ eu-west-2a.



The AZ failure simulation was initiated by the VMware back-end team. At this point all virtual machines in Availability Zone eu-west-2a went offline, including the example virtual machines screenshot above. As expected, within 5 minutes vSphere HA automatically brought the machines online in Availability Zone eu-west-2b. All virtual machines were accessible and working without any further action.

The stretched cluster now shows the hosts in AZ eu-west-2a as unresponsive. The hosts in AZ eu-west-2b are still online and able to run virtual machines.


The warning on the hosts located in AZ eu-west-2b is a vSAN warning because there are cluster nodes down, this is still expected behaviour in the event of host outages.


The vCenter Server and NSX Manager appliances are now located in AZ eu-west-2b.



Availability Zone (AZ) Return to Normal

Once the Availability Zone outage has been resolved, and the ESXi hosts are booted, they return as connected in the cluster. As normal with a vSphere cluster Distributed Resource Scheduler (DRS) will then proceed to balance resources accordingly.


The vSAN object resync takes place and the health checks all change to green. Again this is something that happens automatically, and is managed and monitored by VMware.



Using a third party monitoring tool we can see the brief outage during virtual machine failover, and a server down / return to normal email alert generated for the support team.


This ties in with the vSphere HA events recorded for the ESXi hosts and virtual machines which we can of course view as normal in vCenter.



How to Configure AWS Direct Connect with VMware Cloud on AWS

This post talks about the setup of AWS Direct Connect with VMware Cloud (VMC) on AWS. Direct Connect provides a high-speed, low latency connection between Amazon services and your on-premises environment. Direct Connect is useful for those who want dedicated private connectivity with a consistent network experience in comparison with internet-based VPN connections.

Direct Connect traffic travels over one or more virtual interfaces that you create in your customer AWS account. For SDDCs in which networking is supplied by NSX-T, all Direct Connect traffic, including vMotion, management traffic, and compute gateway traffic, uses a private virtual interface. This establishes a private connection between your on-premises data center and a single Amazon VPC.

You can create multiple interfaces to allow for redundancy and greater availability.”

Using AWS Direct Connect with VMware Cloud on AWS

Make sure you understand the terminology around a Virtual Interface (VIF) and the difference between a Standard VIF, Hosted VIF, and Hosted Connection: What’s the difference between a hosted virtual interface (VIF) and a hosted connection? It is important to consider that VMware Cloud on AWS requires a dedicated Virtual Interface (VIF) – or a pair of VIFs for resilience. If you have a standard 1Gbps or 10Gbps connection direct from Amazon then you can create and allocate VIFs for this purpose. If you are using a hosted connection from an Amazon Partner Network (APN) for sub-1G connectivity then you may need to procure additional VIFs, or a dedicated Direct Connect with the ability to have multiple VIFs on a single circuit. This is a discussion you should have with your APN partner.

Firstly review the pre-requisites and steps to request an AWS Direct Connection connection at Getting Started with AWS Direct Connect. The steps below will walk through configuring Direct Connect for use with VMware Cloud on AWS once the initial connection with Amazon or Amazon partner has been setup. Also review Direct Connect Pricing.

Direct Connect VMC Setup

Log into the VMware on AWS Console, from the SDDCs tab locate the appropriate SDDC and click View Details. Select the Networking & Security tab. Under System click Direct Connect. Make a note of the AWS Account ID, this is the shadow AWS account setup for VMC, you will need this account ID to associate with the Direct Connect.


Log into the AWS console and navigate to the Direct Connect service. If you have not already accepted the connection from your third party provider then review the Amazon documentation referenced above.


Select Virtual Interfaces and click Create Virtual Interface. In this instance we are creating a private VIF. Select the physical connection to use and give the virtual interface a name. Change the virtual interface owner to Another AWS Account and enter the VMC shadow AWS account ID. Fill in the VLAN and BGP ASN information provided by your connection provider. Repeat the process if you are assigning more than one VIF.


Once the VIF or VIFs are created you will see a message that they need to be accepted by the account we have set as owner.


Go back to the VMC portal and the Direct Connect page, click Refresh if necessary. Any interfaces associated with the shadow AWS account will now be listed as available.


Attach the virtual interfaces and confirm acknowledgement that you will be responsible for any data transfer charges that are incurred.


At this point it will take up to 10 minutes for the state of each interface to change from Attaching to Attached, and the BGP status to change from Down to Up. You should now see Advertised BGP Routes listing the network segments you have configured, and Learned BGP Routes listing the subnets peering from your on-premises network.

Click Overview. The Direct Connect shows green, the corresponding VIFs in the AWS Direct Connect page show green and available.


For Direct Connect deep dives review the following blog posts by Nico Vibert: AWS Direct Connect – Deep Dive and Integration with VMware Cloud on AWS, and Direct Connect with VMware Cloud on AWS with VPN as a back-up.

Further Reading: How to Deploy and Configure VMware Cloud on AWS (Part 1), How to Migrate VMware Virtual Machines to VMware Cloud on AWS (Part 2).