It was a Friday in May, and “Sam” – a senior administrator at a major English hospital trust – was preparing to leave for work. When she picked up her phone, she noticed that her inbox had ballooned: “I had all these concerned messages from people I didn’t know.”
The cause of the panic became clear when Sam arrived at the trust. “They had switched off the computer networks; you couldn’t access any of the systems.” She was called into a meeting with the hospital’s senior management who declared a “business continuity incident”. Like 39 other NHS trusts around the country, Sam’s had been paralysed by WannaCry ransomware.
In the months following the attack, British and American intelligence officials traced the computer virus to hackers in North Korea. Their bug had spread indiscriminately through thousands of organisations’ networks and was designed, most cyber security experts now believe, not to generate money, but simply to cause chaos.
“Business continuity status means everything has to go back to paper,” says Sam, whose name has been changed to protect her identity. “We were already full so we had no beds and had to keep sketching the ward layouts. You suddenly realise how reliant you are on technology.”
It was feared the NHS Mail system had been compromised and that confidential patient data would be leaked. Staff at Sam’s trust were forced to abandon the platform. With no other system to share patient data electronically, her team took the decision to cancel all non-emergency and non-maternity appointments and operations for a week.
“I suppose you could say we could’ve gone ahead without access to the electronic systems, but it only takes it to go wrong for one person,” Sam reflects. “I wasn’t confident that patients weren’t being put at risk. You don’t want anyone going in for any sort of invasive treatment if the surgeon and anaesthetist haven’t got the full story.”
Between five and seven thousand patients in Sam’s department alone are thought to have been affected during the course of that week. Around the country, tens of thousands more faced cancellations. “Because we had no way to communicate electronically and securely, you’re risking cancer diagnosis,” Sam explains. “You’re risking delaying people’s treatment, which can be fatal.”
The tragic reality – as it later emerged – was that it was an unnecessary precaution. Chris Flynn, the security lead for NHS Digital, told delegates at the UK Health Show last month that his organisation had failed to explain the limitations of the virus. “We didn’t tell people specifically that NHS Mail was safe,” he said. “We didn’t say it wasn’t, but we didn’t say it was. And we know that people pulled connections.”
The communication failure was one of several reasons the virus hit the health service so hard. While NHS Digital had issued a patch to fix the vulnerability in affected Windows software, a number of hospital trusts’ IT teams had failed to implement it, leaving them exposed when WannaCry started spreading. It was only when then 22-year-old Marcus Hutchins, also known as Malware Tech, accidentally identified a kill-switch that the virus was contained.
In the wake of WannaCry, the government has pledged to spend £50m on improving cyber security and patient data in the NHS, which includes the creation of a £21m fund for the UK’s 27 major trauma centres. NHS Digital has also recently started searching for a supplier of a new cyber security centre to improve the service it offers hospital trusts.
When the government announced the new funding in July, the health minister Lord O’Shaughnessy said: “The NHS has a long history of safeguarding confidential data, but with the growing threat of cyber attacks including the WannaCry ransomware attack in May, this government has acted to protect information across the NHS. Only by leading cultural change and backing organisations to drive up security standards across the health and social care system can we build the resilience the NHS needs in the face of a global threat.”
But while the additional funding was broadly welcomed, some experts have cast doubt on whether it will be enough to transform the cyber security of a distributed behemoth that has underfunded its IT provision for decades.
David Evans, the Chartered Institute for IT’s policy director, questioned the logic in providing extra cyber security funding for major trauma centres, but not for the rest of the NHS’s 240 trusts. “The additional funding will be welcomed by NHS CIOs at major trauma sites, but the rest will have to consider cuts to other areas of budgets to shore up cyber security.”
Aside from the funding, the government has also set strict new targets for trusts. The headline requirement is that they must issue software patches for bugs within 48 hours of NHS Digital making them available. When the Network and Information Systems (NIS) Directive comes into force in May, critical service providers such as hospitals will also be liable to fines of up to 4 per cent of their annual turnover if they fall victim to attacks and fail to prove they have followed guidelines for good cyber hygiene.
Professor Alan Woodward, a cyber security researcher at the University of Surrey, describes the two-day deadline as a classic example of overzealous centralised management. “If you don’t have the resources, it’s like saying everyone needs to be seen in A&E within four hours. If you haven’t got the clinicians, it doesn’t help you. It just gives you a stick to beat people with, and all they do is they find a way of changing the targets.”
Additional support for NHS Digital or the National Cyber Security Centre will not instantly solve the problem, argues Woodward. “If you look at what actually happened in WannaCry, the problem wasn’t actually in the centre,” he says. “NHS Digital had an update ready for this that would’ve stopped it. The problem was the lack of resources out in the individual trusts, so individual trusts either didn’t have the people or the people with the skills to actually roll this out in time.”
NHS Digital’s Dan Taylor says the organisation provides an advisory service to trusts. “We support providers by giving free data security assessments to identify their strengths and weaknesses, to help them understand the nature of the potential threats they face and the steps they need to take to enhance their preparedness. We also provide some consultancy services following these visits to help address any areas of concern.”
It might be easy to update a computer at home, but it’s significantly more difficult in a corporate environment, especially one as complicated as a hospital. “You have to make sure that you don’t mess up all the other applications you have,” explains Woodward. “Although it’s called a National Health Service, there isn’t a National Health Service IT. Every trust is different. They’ve got their own mix of applications and so every trust has to look and make sure they don’t mess up their IT.”
One of the solutions, Woodward says, is to be found in Scotland, where a number of trusts have already invested in technology that simplifies the rollout of software updates. “Rather than have a man in a van with a USB stick upgrading everything, they can do it laterally, they can send all of the updates out.”
Evan and Woodward’s concerns about funding are shared by the health service’s IT leaders. In June, just weeks after the WannaCry virus struck, cloud computing provider VMware surveyed more than a hundred NHS IT decision-makers. Seventy per cent said the NHS was not allocating enough funding to cyber security. Over a quarter had been forced to cancel or postpone appointments due to cyber incidents, and nearly a third said they were certain that electronic patient data had been infiltrated by hackers.
Despite the government’s plans for improving hospitals’ cyber security, Sam isn’t convinced that WannaCry will be the last strike to cause significant disruption in the health service: “I would like to say it will be, but I don’t think we can reliably say that. Until we’re in the situation where a critical service is properly resourced in every way it needs to be, in terms of people, infrastructure and estates, we’re always going to be running at a risk. Technology moves so quickly and the NHS does not. It’s too big and it’s not in the fiscal situation to keep up.”