Last may, several NHS hospitals were hit by the global WannaCry ransomware attack.
Britain said on Friday it believed North Korea was behind the "WannaCry" cyber attack in May that disrupted businesses and government services worldwide, including the National Health Service (NHS) in England.
The report said NHS trusts had not acted on critical alerts from NHS Digital and a warning from the Department of Health and the Cabinet Office in 2014 to patch or migrate away from vulnerable older software. "It was a relatively unsophisticated attack and could have been prevented by the NHS following basic IT security best practice", said Amyas Morse, head of the NAO.
For example, the Secretary of State for Health asked the National Data Guardian and the Care Quality Commission to undertake reviews of data security, with reports published in July 2016 that warned the Department of Health that cyber attacks could lead to patient information being lost or compromised.
The cyber attack could have caused more disruption if it had not been stopped by a cyber researcher activating a "kill switch" so that WannaCry stopped locking devices.
Prior to the attack, the Department of Health didn't have any formal mechanism for checking whether local NHS organisations were following their advice on cybersecurity issues.
The full scale of the incident saw over 19,000 medical appointments cancelled, according to the report, and computers at 600 surgeries shut down.
"The Department of Health failed to agree a plan with the NHS locally for dealing with cyber attacks so the NHS response came too late in the day".
At least 6,900 NHS appointments were cancelled as a result of the attack.
It had been warned about the risks of cyberattacks more than a year before.
No NHS organisations paid the ransom demanded by the malware.
An assessment of 88 out of 236 trusts by NHS Digital before the attack found that none passed the required cyber-security standards. "However, the NAO said, the Department of Health "does not know" how many NHS organisations could not access records or receive information, because they shared data or systems with an infected trust".
The lack of a rehearsal for an attack meant "it was not immediately clear who should lead the response and there were problems with communications".
All were running computer systems - the majority Windows 7 - that had not been updated to secure them against such attacks.
The report concluded by saying that the NHS accepted there were "lessons to learn" from the attack, and that it was taking action to make sure an attack of this magnitude did not happen again.
"The WannaCry cyber attack had potentially serious implications for the NHS and its ability to provide care to patients".
In one way, the NHS was lucky - if, instead of a Friday in May, the attack had taken place on a Monday in winter, with a week's appointments affected, the damage would have been far worse.
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