Improving wheelchair user access to posture and mobility services in NHS Wales: a cross-sectional demand-weighted p-median analysis to minimise wheelchair user travel time

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Wheelchair provisions are essential for independence among individuals with mobility impairment, yet geographic barriers limit access to specialist wheelchair services in rural Wales. This study applies demand-weighted p-median optimisation to identify configurations minimising travel burden and spatial inequity. A cross-sectional analysis of 43,790 wheelchair users across 1,917 Welsh lower super output areas was conducted using mixed-integer p-median programming on a road-network travel time matrix. Ten scenarios were evaluated: baseline, unconstrained, relocations, and satellite additions. Access was measured by median/maximum travel times, proportion of users within 30/60 min of the nearest service, and demand-weighted Gini coefficient. At baseline, median travel time was 19.22 min (IQR 14.07), with a Gini coefficient of 0.3562. Individual clinic relocation produced negligible improvement in spatial equity across all four scenarios. Adding one satellite clinic in west Wales reduced median travel time in Pembrokeshire by 42.4 min and reduced the Gini coefficient to 0.329 without worsening access in any local authority. A second satellite in mid Wales further reduced the Gini coefficient to 0.2868; all configurations were stable under bootstrap demand sensitivity analysis. The geographic inequity in access to the All-Wales Posture and Mobility Service is driven by the absence of provision in west and mid Wales rather than by the suboptimal positioning of existing clinics. Satellite provision in west Wales is identified as the single most impactful reconfiguration available, with mid Wales representing the next priority location. These findings should inform further strategic service planning options for posture and mobility services. Geographic distance is a structural barrier to wheelchair service access in Wales, with a substantial proportion of users in mid and west Wales facing journeys exceeding 90 minutes to their nearest posture and mobility centre, directly compromising timely assessment, prescription review, and equipment maintenance for this population.Relocating existing clinics does not address the geographic access deficit; the fundamental problem in geographic inequity to wheelchair services in Wales is the absence of provision in west and mid Wales, and rehabilitation service planners should focus investment on satellite expansion rather than reconfiguration of existing sites.Satellite provision in west Wales represents the single most impactful and equitable reconfiguration available and should be prioritised to improve access to complex assistive technology services without displacing provision for any existing service users; a second satellite in mid Wales is identified as the logical next priority, producing further substantial access gains for two of the most geographically isolated populations in Wales. Geographic distance is a structural barrier to wheelchair service access in Wales, with a substantial proportion of users in mid and west Wales facing journeys exceeding 90 minutes to their nearest posture and mobility centre, directly compromising timely assessment, prescription review, and equipment maintenance for this population. Relocating existing clinics does not address the geographic access deficit; the fundamental problem in geographic inequity to wheelchair services in Wales is the absence of provision in west and mid Wales, and rehabilitation service planners should focus investment on satellite expansion rather than reconfiguration of existing sites. Satellite provision in west Wales represents the single most impactful and equitable reconfiguration available and should be prioritised to improve access to complex assistive technology services without displacing provision for any existing service users; a second satellite in mid Wales is identified as the logical next priority, producing further substantial access gains for two of the most geographically isolated populations in Wales.

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