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

PURPOSE: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.