This represents good compliance with the NIHR OA mandate, and there is scope for further improvement. Papers with a co-author affiliated with a higher education university are more likely to be available OA (80% vs. 65%). There is some degree of overlap, of course, as some papers include authors from both sectors. This suggests that looking to good practice in the UK university sector offers insight about good ways forward. Our qualitative research (see Appendix 5) suggests that there is

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... for the principles of Open Access by researchers, research managers, and library and information professionals in the health and social care system. Funding for APCs is the primary barrier to researchers publishing their articles OA, however researchers affiliated to, or collaborating with someone affiliated to, universities have less difficulty making their research outputs available OA. Central funding, for example block grants, would drive beneficial change as would centralised and strengthened engagement with publishers, and more education and training. Finally, OA is essential but not enough in itself as there is a clear need for short, actionable summaries of research outputs to inform clinical practice. The following recommendations focus on opportunities to increase value for money to the taxpayer by eliminating elements of double payment in this system (for subscriptions and OA publication), by raising standards through better access to research information, and by ensuring publicly funded research information is opened for wider economic and social gain.