A decade on, schools are filling ever-growing gaps in NHS provision. In particular, a lack of clarity and misuse of the SEN and SEND terms have quietly skewed the SEND landscape. The Children and Families Act 2014 tightly defines SEN, which is linked to the requirement for special educational provision (SEP). Where needs require health provision falling outside SEN/SEP and reasonable adjustments, responsibility should remain with the NHS. Delivering this will require that compliant NHS services be embedded in educational settings, including an equitable model for NHS-commissioned clinical nursing services in schools.