Azure Security and Compliance Blueprint: PaaS Web Application for UK NHS


This Azure Security and Compliance Blueprint provides a reference architecture and guidance for a platform as a service (PaaS) solution suitable for the collection, storage, and retrieval of healthcare data. This solution demonstrates ways in which customers can comply with guidance provided in the Cloud Security Good Practice Guide published by NHS Digital, a partner of the United Kingdom's (UK) Department of Health and Social Care (DHSC). The Cloud Security Good Practice Guide is based on the 14 Cloud Security Principles published by the UK National Cyber Security Centre (NCSC).

This reference architecture, implementation guide, and threat model are intended to serve as a foundation for customers to adjust to their specific requirements and should not be used as-is in a production environment without additional configuration. Customers are responsible for conducting appropriate security and compliance assessments of any solution built using this architecture, as requirements may vary based on the specifics of each customer's implementation.

Architecture diagram and components

This solution provides a reference architecture for a PaaS web application with an Azure SQL Database backend. The web application is hosted in an isolated Azure App Service Environment, which is a private, dedicated environment in an Azure datacenter. The environment load balances traffic for the web application across virtual machines managed by Azure. All external connections require TLSv1.2. This architecture also includes network security groups, an Application Gateway, Azure DNS, and Load Balancer.

The solution uses Azure Storage accounts, which customers can configure to use Storage Service Encryption to maintain confidentiality of data at rest. Azure stores three copies of data within a customer's selected datacenter for resiliency. Geographic redundant storage ensures that data will be replicated to a secondary datacenter hundreds of miles away and stored again as three copies within that datacenter, preventing an adverse event at the customer's primary data center from resulting in a loss of data.

For enhanced security, all resources in this solution are managed as a resource group through Azure Resource Manager. Azure Active Directory role-based access control is used for controlling access to deployed resources and keys in Azure Key Vault. System health is monitored through Azure Security Center and Azure Monitor. Customers configure both monitoring services to capture logs and display system health in a single, easily navigable dashboard. Azure Application Gateway is configured as a firewall in prevention mode and disallows traffic that is not TLSv1.2. The solution utilizes Azure Application Service Environment v2 to isolate the web tier in a non-multi-tenant environment.

Microsoft recommends configuring a VPN or ExpressRoute connection for management and data import into the reference architecture subnet.

PaaS Web Application for UK NHS reference architecture diagram

This solution uses the following Azure services. Details of the deployment architecture are in the deployment architecture section.

  • Application Gateway
    • Web application firewall
      • Firewall mode: prevention
      • Rule set: OWASP
      • Listener port: 443
  • Azure Active Directory
  • Azure Application Service Environment v2
  • Azure Automation
  • Azure DNS
  • Azure Key Vault
  • Azure Load Balancer
  • Azure Monitor
  • Azure Resource Manager
  • Azure Security Center
  • Azure SQL Database
  • Azure Storage
  • Azure Virtual Network
    • Network security groups
  • Azure Web App

Deployment architecture

The following section details the deployment and implementation elements.

Azure Resource Manager: Azure Resource Manager enables customers to work with the resources in the solution as a group. Customers can deploy, update, or delete all the resources for the solution in a single, coordinated operation. Customers use a template for deployment and that template can work for different environments such as testing, staging, and production. Resource Manager provides security, auditing, and tagging features to help customers manage their resources after deployment.

App Service Environment v2: The Azure App Service Environment is an App Service feature that provides a fully isolated and dedicated environment for securely running App Service applications at a high scale.

The App Service Environment is isolated to only run a single application and is always deployed into a virtual network. This isolation feature enables the reference architecture to have complete tenant isolation, removing it from Azure’s multi-tenant environment. This isolation feature is required to meet the requirements of UK NHS principle 3. Customers have fine-grained control over both inbound and outbound application network traffic, and applications can establish high-speed secure connections over virtual networks to on-premises corporate resources. Customers can “auto-scale” with App Service Environment based on load metrics, available budget, or a defined schedule.

Use of App Service Environment for this architecture allows for the following controls/configurations:

Azure Web App: Azure App Service enables customers to build and host web applications in the programming language of their choice without managing infrastructure. It offers auto-scaling and high availability, supports both Windows and Linux, and enables automated deployments from GitHub, Azure DevOps, or any Git repo.

Virtual Network

The architecture defines a private virtual network with an address space of

Network security groups: Network security groups contain access control lists that allow or deny traffic within a virtual network. Network security groups can be used to secure traffic at a subnet or individual virtual machine level. The following Network security groups exist:

  • 1 network security group for Application Gateway
  • 1 network security group for App Service Environment
  • 1 network security group for Azure SQL Database

Each of the Network security groups have specific ports and protocols open so that the solution can work securely and correctly. In addition, the following configurations are enabled for each network security group:

Subnets: Each subnet is associated with its corresponding network security group.

Azure DNS: The Domain Name System, or DNS, is responsible for translating (or resolving) a website or service name to its IP address. Azure DNS is a hosting service for DNS domains that provides name resolution using Azure infrastructure. By hosting domains in Azure, users can manage DNS records using the same credentials, APIs, tools, and billing as other Azure services. Azure DNS also supports private DNS domains.

Azure Load Balancer: Azure Load Balancer allows customers to scale their applications and create high availability for services. Load Balancer supports inbound as well as outbound scenarios, and provides low latency, high throughput, and scales up to millions of flows for all TCP and UDP applications.

Data in transit

Azure encrypts all communications to and from Azure datacenters by default. All transactions to Azure Storage through the Azure portal occur via HTTPS.

Data at rest

The architecture protects data at rest through encryption, database auditing, and other measures.

Azure Storage: To meet encrypted data at rest requirements, all Azure Storage uses Storage Service Encryption. This helps protect and safeguard data in support of organizational security commitments and compliance requirements defined by NHS Digital.

Azure Disk Encryption: Azure Disk Encryption leverages the BitLocker feature of Windows to provide volume encryption for data disks. The solution integrates with Azure Key Vault to help control and manage the disk-encryption keys.

Azure SQL Database: The Azure SQL Database instance uses the following database security measures:

  • Active Directory authentication and authorization enables identity management of database users and other Microsoft services in one central location.
  • SQL database auditing tracks database events and writes them to an audit log in an Azure storage account.
  • Azure SQL Database is configured to use transparent data encryption, which performs real-time encryption and decryption of the database, associated backups, and transaction log files to protect information at rest. Transparent data encryption provides assurance that stored data has not been subject to unauthorized access.
  • Firewall rules prevent all access to database servers until proper permissions are granted. The firewall grants access to databases based on the originating IP address of each request.
  • SQL Threat Detection enables the detection and response to potential threats as they occur by providing security alerts for suspicious database activities, potential vulnerabilities, SQL injection attacks, and anomalous database access patterns.
  • Encrypted Columns ensure that sensitive data never appears as plaintext inside the database system. After enabling data encryption, only client applications or application servers with access to the keys can access plaintext data.
  • SQL Database dynamic data masking limits sensitive data exposure by masking the data to non-privileged users or applications. Dynamic data masking can automatically discover potentially sensitive data and suggest the appropriate masks to be applied. This helps to identify and reduce access to data such that it does not exit the database via unauthorized access. Customers are responsible for adjusting dynamic data masking settings to adhere to their database schema.

Identity management

The following technologies provide capabilities to manage access to data in the Azure environment:

  • Azure Active Directory is Microsoft's multi-tenant cloud-based directory and identity management service. All users for this solution are created in Azure Active Directory, including users accessing the Azure SQL Database.
  • Authentication to the application is performed using Azure Active Directory. For more information, see integrating applications with Azure Active Directory. Additionally, the database column encryption uses Azure Active Directory to authenticate the application to Azure SQL Database. For more information, see how to protect sensitive data in Azure SQL Database.
  • Azure role-based access control enables administrators to define fine-grained access permissions to grant only the amount of access that users need to perform their jobs. Instead of giving every user unrestricted permission for Azure resources, administrators can allow only certain actions for accessing data. Subscription access is limited to the subscription administrator.
  • Azure Active Directory Privileged Identity Management enables customers to minimize the number of users who have access to certain information. Administrators can use Azure Active Directory Privileged Identity Management to discover, restrict, and monitor privileged identities and their access to resources. This functionality can also be used to enforce on-demand, just-in-time administrative access when needed.
  • Azure Active Directory Identity Protection detects potential vulnerabilities affecting an organization's identities, configures automated responses to detected suspicious actions related to an organization's identities, and investigates suspicious incidents to take appropriate action to resolve them.


Secrets management: The solution uses Azure Key Vault for the management of keys and secrets. Azure Key Vault helps safeguard cryptographic keys and secrets used by cloud applications and services. The following Azure Key Vault capabilities help customers protect and access such data:

  • Advanced access policies are configured on a need basis.
  • Key Vault access policies are defined with minimum required permissions to keys and secrets.
  • All keys and secrets in Key Vault have expiration dates.
  • All keys in Key Vault are protected by specialized hardware security modules. The key type is a hardware security module protected 2048-bit RSA Key.
  • All users and identities are granted minimum required permissions using role-based access control.
  • Diagnostics logs for Key Vault are enabled with a retention period of at least 365 days.
  • Permitted cryptographic operations for keys are restricted to the ones required.

Azure Security Center: With Azure Security Center, this solution can centrally apply and manage security policies across workloads, limit exposure to threats, and detect and respond to attacks. Additionally, Azure Security Center accesses existing configurations of Azure services to provide configuration and service recommendations to help improve security posture and protect data.

Azure Security Center uses a variety of detection capabilities to alert customers of potential attacks targeting their environments. These alerts contain valuable information about what triggered the alert, the resources targeted, and the source of the attack. Azure Security Center has a set of predefined security alerts, which are triggered when a threat, or suspicious activity takes place. Custom alert rules in Azure Security Center allow customers to define new security alerts based on data that is already collected from their environment.

Azure Security Center provides prioritized security alerts and incidents, making it simpler to discover and address potential security issues. A threat intelligence report is generated for each detected threat to assist incident response teams in investigating and remediating threats.

Azure Application Gateway: The architecture reduces the risk of security vulnerabilities using an Azure Application Gateway with a web application firewall configured, and the OWASP ruleset enabled. Additional capabilities include:

Logging and auditing

Azure services extensively log system and user activity, as well as system health:

  • Activity logs: Activity logs provide insight into operations performed on resources in a subscription. Activity logs can help determine an operation's initiator, time of occurrence, and status.
  • Diagnostic logs: Diagnostic logs include all logs emitted by every resource. These logs include Windows event system logs, Azure Storage logs, Key Vault audit logs, and Application Gateway access and firewall logs. All diagnostic logs write to a centralized and encrypted Azure storage account for archival. The retention is user-configurable, up to 730 days, to meet organization-specific retention requirements.

Azure Monitor logs: These logs are consolidated in Azure Monitor logs for processing, storing, and dashboard reporting. Once collected, the data is organized into separate tables for each data type, which allows all data to be analyzed together regardless of its original source. Furthermore, Azure Security Center integrates with Azure Monitor logs allowing customers to use Kusto queries to access their security event data and combine it with data from other services.

The following Azure monitoring solutions are included as a part of this architecture:

  • Active Directory Assessment: The Active Directory Health Check solution assesses the risk and health of server environments on a regular interval and provides a prioritized list of recommendations specific to the deployed server infrastructure.
  • SQL Assessment: The SQL Health Check solution assesses the risk and health of server environments on a regular interval and provides customers with a prioritized list of recommendations specific to the deployed server infrastructure.
  • Agent Health: The Agent Health solution reports how many agents are deployed and their geographic distribution, as well as how many agents which are unresponsive and the number of agents which are submitting operational data.
  • Activity Log Analytics: The Activity Log Analytics solution assists with analysis of the Azure activity logs across all Azure subscriptions for a customer.

Azure Automation: Azure Automation stores, runs, and manages runbooks. In this solution, runbooks help collect logs from Azure SQL Database. The Automation Change Tracking solution enables customers to easily identify changes in the environment.

Azure Monitor: Azure Monitor helps users track performance, maintain security, and identify trends by enabling organizations to audit, create alerts, and archive data, including tracking API calls in their Azure resources.

Threat model

The data flow diagram for this reference architecture is available for download or can be found below. This model can help customers understand the points of potential risk in the system infrastructure when making modifications.

PaaS Web Application for UK NHS threat model

Compliance documentation

The Azure Security and Compliance Blueprint – UK NHS Customer Responsibility Matrix lists all UK NHS requirements. This matrix details whether the implementation of each principle is the responsibility of Microsoft, the customer, or shared between the two.

The Azure Security and Compliance Blueprint – UK NHS PaaS Web Application Implementation Matrix provides information on which UK NHS requirements are addressed by the PaaS web application architecture, including detailed descriptions of how the implementation meets the requirements of each covered principle.

Guidance and recommendations

VPN and ExpressRoute

A secure VPN tunnel or ExpressRoute needs to be configured to securely establish a connection to the resources deployed as a part of this PaaS web application reference architecture. By appropriately setting up a VPN or ExpressRoute, customers can add a layer of protection for data in transit.

By implementing a secure VPN tunnel with Azure, a virtual private connection between an on-premises network and an Azure virtual network can be created. This connection takes place over the Internet and allows customers to securely "tunnel" information inside an encrypted link between the customer's network and Azure. Site-to-site VPN is a secure, mature technology that has been deployed by enterprises of all sizes for decades. The IPsec tunnel mode is used in this option as an encryption mechanism.

Because traffic within the VPN tunnel does traverse the Internet with a site-to-site VPN, Microsoft offers another, even more secure connection option. Azure ExpressRoute is a dedicated WAN link between Azure and an on-premises location or an Exchange hosting provider. As ExpressRoute connections do not go over the Internet, these connections offer more reliability, faster speeds, lower latencies, and higher security than typical connections over the Internet. Furthermore, because this is a direct connection of customer's telecommunication provider, the data does not travel over the Internet and therefore is not exposed to it.

Best practices for implementing a secure hybrid network that extends an on-premises network to Azure are available.


  • This document is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED, OR STATUTORY, AS TO THE INFORMATION IN THIS DOCUMENT. This document is provided "as-is." Information and views expressed in this document, including URL and other Internet website references, may change without notice. Customers reading this document bear the risk of using it.
  • This document does not provide customers with any legal rights to any intellectual property in any Microsoft product or solutions.
  • Customers may copy and use this document for internal reference purposes.
  • Certain recommendations in this document may result in increased data, network, or compute resource usage in Azure, and may increase a customer's Azure license or subscription costs.
  • This architecture is intended to serve as a foundation for customers to adjust to their specific requirements and should not be used as-is in a production environment.
  • This document is developed as a reference and should not be used to define all means by which a customer can meet specific compliance requirements and regulations. Customers should seek legal support from their organization on approved customer implementations.