NHS 111 Services Held to Ransom by Cyber Attack

NHS 111 services are down for much of the UK following a cyber-attack Thursday morning against the infrastructure of software vendor 'Advanced'. The company's Adastra system is used by call handlers to dispatch ambulances, to book urgent care appointments, and for out of office hours emergency prescriptions. It’s Caresys software is used extensively across more than 1,000 care homes, while Carenotes, Crosscare and Staffplan are used extensively by providers. Advanced supplies software to NHS facilities and doctors nationally, including hospitals, doctors’ offices, care homes and mental health services, so disruption has been widespread.

The systems outage is causing significant delays as call handlers are forced to use other systems or to revert to paper. Emergency ambulance dispatch is taking priority it has been reported, meaning that everyone else has to wait. Meanwhile, applications managed by Advanced have been isolated to prevent lateral spread of malware to other NHS systems.

According to the Telegraph, the cyber-attack appears to have been conducted by an organized criminal ransomware group looking to shut down crucial systems rather than a hostile state-actor as had been originally feared. Healthcare and other critical national infrastructure services have been on high alert since the start of the war in Ukraine given heightened tensions with Moscow. The UK’s National Cyber Security Centre is working with the NHS as it attempts to recover systems from backups and restore services.

UK businesses have been warned about paying ransoms and incentivizing extortionists. According to the Telegraph last month, the head of the UK’s National Cyber Security Centre (NCSC) and the Information Commissioner warned businesses that they risked “incentivizing” attacks by cybercrime gangs by paying ransom demands.

According to Sky News, Advanced, said the issue was contained to "a small number of servers" representing 2% of its health and care infrastructure. Chief operating officer Simon Short added: "We continue to work with the NHS and health and care bodies as well as our technology and security partners, focused on recovery of all systems over the weekend and during the early part of next week."

This latest cyber-attack against the NHS is an unwelcome test of its resiliency and preparedness for various outages including cyber-extortion. As a critical infrastructure industry, the NHS is a target for pariah nation state attack, although in this case evidence appears to suggest that the attack was orchestrated by a Russian criminal gang. Given the known close working relationship between the Russian government and the country’s organized crime gangs, the Kremlin may not be entirely off the hook in this case. A forensic investigation of the cyberattack will take time and a positive attribution of the attackers may be many months away.


NSH 111 services previously known as ‘NHS Direct’ is used for non-emergency Urgent Care services and puts callers in touch with highly trained advisers supported by healthcare professionals. It was designed to reduce the call volume on the UK’s 999 Emergency services (similar to the US’s 911 call system) for non-critical healthcare issues, or to force patients to have to wait several days for an appointment with their general practitioner / primary care provider. The free 111 service is widely used and can be accessed by anyone dialing the number from within the UK.

Advanced is owned by Vista Equity Partners and BC Partners.

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Ai Will Radically Change Healthcare Security

Artificial intelligence is becoming increasingly important in the defense of healthcare providers and patients, while the number and size of cyber attacks against the industry continues to rise to unprecedented levels. All this at a time when many of us are distracted by the current pandemic and in dire need of health services - perhaps now more than ever in our past, other than perhaps in times of kinetic military conflict.

Our outdated security tools and other controls simply cannot cope with sophisticated APTs - (advanced persistent threats) from pariah nation state military espionage units. Nor can it cope with a newly emboldened Eastern Mafia, where organized crime syndicates operate with impunity from behind the former Iron Curtain, seemingly immune from local law enforcement, prosecution, or deportation to the civilized world, where law and order still largely prevail.

Many of these attacks in fact, whether conducted by military officers or proxies, are nothing more than a form of cyber warfare in order to further the political and economic objectives of their host regimes. Destabilizing the more successful west has been an ambition of the USSR since the advent of the Cold War. Today cyber attacks and information warfare add a new dimension to achieve this lasting objective in the competition for global power. Indeed this cyber conflict has been carefully engineered to take advantage of the trickle technique, where on an ongoing trickle of seemingly innocuous minor attacks has been engineered to weaken the internals of other countries over time, careful not to cross a line in the sand that might cause a massive kinetic or other response from the nation being attacked. 

Mainland China's objectives appear to be similar to that of the Russian Federation in its goals of world domination, only less focused on fermenting internal division and more on obtuse power conflict and long term theft of any advantages other nations, including the Russian Federation may possess.

The fact it that as cyber defenders we need better tools to defend and protect against attackers and higher levels of automation since we are out-gunned and out-manned at least 5 to 1 attackers to defenders.

In my presentation below I talk about the rising tide of sophisticated well funded cyber adversaries, the advent of deepfakes, CEO Fraud or Business Email Compromise (BEC) as its also known, and how AI is making these scams even more convincing and difficult to detect. I talk about the need for us to develop and implement AI-based cyber defensive tools to inoculate our networks against attacks. I discuss the need to protect healthcare providers, staff and patients from attack that could result in patient harm or even death. Increased automation and machine intelligence will permit us to respond quickly and thoroughly, and to thwart attacks before patient safety and HIT system availability are impacted.

In healthcare, we need to up our game on the security front. We need to understand what we have connected to our healthcare networks and what risks they pose. We need better threat intelligence and we need better defensive tools to protect against attack. We also need to remove the need and delay for humans to intervene against attacks in process.

As healthcare continues to digitize for improved interoperability and efficiency, cybersecurity needs to be front and center in design considerations and budget allocation if more deaths are to be avoided. Watch my 30 minute presentation below for more on this subject.

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