They're in your classroom.
You just don't know it yet.

Across England, schools routinely refuse to send work home for students who are too unwell to attend. The reasoning seems logical on the surface — if you're too ill for school, you're too ill to work. But this conflates physical presence with cognitive capacity, and for students with chronic conditions, the two are not the same thing.

Endometriosis, POTS, and hypermobility flare and remit. A student may be incapable of getting dressed, travelling, and sitting upright for seven hours on a Tuesday morning — yet entirely capable of working through a maths worksheet at 7pm that same evening when her body has eased. Her GCSE grade does not care whether she completed the work at 9am or 9pm. Her future does.

Remote learning as a reasonable adjustment for students with diagnosed chronic conditions is exactly what the Equality Act 2010 envisages. It is not a reward for good attendance. It is not a bonus. It is a reasonable adjustment to a substantial disadvantage — which is precisely the legal test. Schools that refuse it are not cautious. They are non-compliant.

Persistent absence thresholds, attendance warnings, and parental prosecution letters were designed for avoidable absence. They were not designed for a student with endometriosis who is managing a chronic condition that causes her to be incapacitated for three to seven days every month — roughly 36 to 84 days every academic year — before she has even had a diagnosis.

Yet these students receive the same letters. Their parents receive the same calls. Their absence goes down in the same register. And in academies with strict attendance-linked interventions, students with medical conditions are being penalised for a system that has failed to distinguish between wilful truancy and physical incapacity.

The DfE's guidance is clear that schools should take medical evidence into account when applying attendance policies. What is less clear — and rarely implemented — is a proactive framework for doing so. Schools wait for parents to advocate. They wait for GP letters. They wait to be told. Students without assertive parents, or students whose conditions haven't yet been diagnosed, fall through every time.

When a school encounters a student with endometriosis, POTS, or EDS, it reaches for the nearest available framework — and that framework is almost always SEND. Special Educational Needs and Disability provision has expanded significantly, and schools have developed real expertise in supporting students with ADHD, autism, and learning differences. But chronic physical illness is not the same as a neurodevelopmental condition, and the strategies, adjustments, and staff training designed for one do not transfer to the other.

A student with ADHD needs consistency, structure, and specific pedagogical approaches. A student with endometriosis needs pain management access, flexible deadlines, remote learning options, and a member of staff who doesn't dismiss her when she says she can't sit down. These are different problems. They need different solutions.

The result is that chronic illness gets under-resourced because it doesn't fit neatly into existing SEND structures, and over-medicalised because nobody quite knows where else to put it. Students with endometriosis end up on EHCP waiting lists when what they actually need is a compassionate member of staff and a remote access policy.

In previous decades, the school medical room was a room. A bed. A trained member of staff. Somewhere a student in genuine pain could go and lie down for twenty minutes, feel marginally human again, and return to class. The standard was not high. But it was a standard.

Today, in a significant number of secondary schools, the medical room is a chair, a fridge, and a first aid box. For a student with endometriosis experiencing a severe flare — pain that is clinically comparable to labour, for which she has no diagnosis and possibly no medication — there is nowhere to go that offers even basic comfort. She is expected to sit in a chair. Then return to lessons.

Heat therapy — a hot water bottle, a heat pad — is one of the most effective and accessible ways to manage endometriosis and menstrual pain in real time. Many schools have policies against hot water bottles for health and safety reasons. Heat pads are permitted in most, but only if the student brings one. For students from lower-income households, or students who simply forgot, or students who didn't expect a flare today because their condition is unpredictable — access to basic pain management should not depend on whether you could afford to pack it this morning.

Endometriosis, POTS, and EDS all qualify as disabilities under the Equality Act 2010 where they have a substantial and long-term adverse effect on normal day-to-day activities. The Act imposes an anticipatory duty on schools — meaning they should not wait for a student to tell them about her condition before making adjustments. They should already have thought about it.

Section 100 of the Children and Families Act 2014 places a statutory duty on school governing bodies to make arrangements for the support of pupils with medical conditions. This is not guidance. It is a legal duty. And schools are routinely failing to meet it — not because they are deliberately discriminatory, but because they simply do not know that these conditions exist, qualify, and require action.

When schools cite staffing levels or capacity as reasons for not providing remote access, not creating IHPs, or not making reasonable adjustments — they are not citing a legal defence. Resource constraints do not extinguish the obligation. They may affect what is "reasonable" in the adjustments test, but the duty to do something remains absolute.

Endometriosis affects 1 in 10 girls. But it will touch almost everyone — because the boys sitting next to them in class will become partners, fathers, employers, GPs, and friends to women living with it. The moment you tell a boy that the woman he will eventually care about has a 1 in 10 chance of having a condition he's never heard of — the conversation changes entirely.

Only 31% of men know what endometriosis is. That statistic does not begin in adulthood. It begins in the classroom, in the moment nobody mentioned it. Boys who are educated about chronic illness become men who do not dismiss it. They become the colleague who covers when she can't come in. The partner who goes to the appointment. The manager who doesn't question the sick day. The friend who knows what she's dealing with.

EDS and POTS affect boys too — though they are diagnosed even later in males than females. Boys with hypermobility are told they are clumsy, unathletic, attention-seeking. They are not. They are undiagnosed. An education programme that reaches boys as well as girls catches both.