Research Consulting is pleased to share a new report, Strategic review and feasibility study of Open Access models, exploring current use of Open Access publishing in NHS Wales, and options for expanding this in future.
Commissioned by NHS Wales e‑Library (Digital Health and Care Wales) and the Wales Higher Education Libraries Forum (WHELF), the study sets out practical options to increase and encourage the use of Open Access (OA) approaches for health and care research publications in Wales.
The report is available both in English and Welsh at https://zenodo.org/records/18925163.
The report explores the challenges facing health systems in managing the vast amount of knowledge they generate. From service evaluations and quality improvement initiatives to clinical guidance and research studies, valuable insights are constantly being created. Yet much of this work remains difficult to discover, share or reuse beyond the teams that produced it. The questions addressed in this report extend beyond Wales, and beyond publishing.
The visibility gap is structural not cultural
The study combined bibliometric analysis, stakeholder interviews across NHS Wales and Welsh universities, and comparative case studies from other health systems. One of the clearest findings is how heavily Open Access rates depend on who you are publishing with. Where NHS Wales staff co-author with university colleagues, OA rates are broadly comparable to sector averages. Where they publish independently, which accounts for 37% of NHS Wales publications over the last decade, only 45% of outputs are openly accessible, well below the 64% UK average for health-related publications.
Stakeholders across NHS Wales and higher education were clear about why this matters. Better access to evidence supports better decisions, reduces duplicated effort, and keeps publicly funded knowledge in the public domain rather than locked behind journal subscriptions.
This structural gap becomes most visible in the treatment of grey literature. Quality improvement reports, audit findings, service evaluations and clinical guidance represent the working knowledge of a health system, yet often have no reliable place to live. Without repository infrastructure, these materials circulate informally, if at all, and the institutional memory they represent remains fragile.
Building infrastructure is the most practical first step
The report assesses four possible approaches, ranging from maintaining current practice to establishing a full Diamond Open Access Press. Our recommendations focus on two practical steps designed to build capacity over time.
- Build an NHS Wales repository as a scalable first step. This would provide a consistent way to capture and share outputs across organisations, particularly grey literature such as service evaluations and quality improvement work.
- Pilot a Diamond Open Access journal in a defined subject area. This would create fee-free publication routes for NHS staff and collaborators, while testing appetite and feasibility for community-led publishing.
Both recommendations require additional investment and a formal business case to Welsh Government. However, they build on existing initiatives, including the Digital Health and Care Wales repository, and examples from other parts of the UK and Ireland and strengths such as the good relationships between libraries in NHS Wales and Welsh universities.
Alongside these headline recommendations, the report also identifies enabling actions. These include developing a system-wide OA policy, improving how NHS Wales authors identify their affiliations, mapping relevant professional communities, and strengthening links with university presses and external networks working on similar challenges.
Treating grey literature as an asset unlocks hidden value
The NHS Wales context is specific, but the underlying challenge is widely shared. Many organisations generate valuable knowledge that never becomes fully visible.
Grey literature, including service evaluations, audit findings and locally developed guidance – often contains insights that directly improve services. Yet it is frequently treated as peripheral rather than strategic. This project reinforces the idea that grey literature should be managed as an organisational asset. Capturing and sharing this material systematically strengthens institutional memory and reduces the risk of repeating work that has already been done elsewhere.
Policy and infrastructure must develop together
One of the clearest lessons from the work is that infrastructure alone is not enough. Technology provides the platform, but policy provides the direction.
Successful OA implementation requires both systems that enable sharing, and policies that encourage consistent use. Without alignment between the two, initiatives risk becoming fragmented or underused.
This applies equally to repository development and emerging publishing models. Clear guidance, shared expectations and practical support all play an essential role in embedding OA into everyday workflows.
Collaboration increases reach, resilience and sustainability
Partnerships emerged as a recurring theme throughout the project. Collaboration between NHS organisations, universities and professional communities strengthens both capacity and credibility.
Repository infrastructure benefits from shared expertise. Publishing initiatives benefit from shared editorial networks and national or regional coordination creates opportunities to build scalable solutions that individual organisations could not sustain alone.
The case for Diamond Open Access, where content is free to read and free to publish, is growing – particularly in health and care settings where article processing charges can be a barrier. However, these models require careful planning. Community enthusiasm alone cannot sustain infrastructure; funding and governance must be addressed from the outset.
Bilingual publishing reflects wider commitments to access
A notable feature of this project is the publication of the final report in both English and Welsh, the first Research Consulting report delivered bilingually. This reflects the linguistic context of NHS Wales and reinforces the principles that accessibility is cultural as well as technical. Bilingual publication demonstrates how Open Access initiatives can support inclusive communication and ensure knowledge reaches the communities it is intended to serve.
Discoverability as a first step toward impact
Ultimately, Open Access is not simply about publishing more content. It is about enabling knowledge to move across teams, organisations and professional boundaries. When healthcare knowledge becomes easier to find and reuse, it becomes more likely to inform practice, support innovation and improve outcomes.
For organisations considering similar initiatives, the experience of NHS Wales offers a clear starting point: discoverability comes first, and getting there is as much a strategic choice as a technical one.
