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School food standards in England aim to support healthy diets for all pupils, including those with special educational needs and disabilities (SEND). While dietary advice is consistent across groups, SEND pupils may face unique challenges such as physical and sensory-related eating and drinking difficulties and higher rates of overweight. Nearly 45% of specialist school pupils qualify for Free School Meals (FSM). Despite the potential for school food to improve health outcomes, research on UK specialist school food provision remains limited. A qualitative study was conducted in four purposively sampled specialist schools in North East England. Data were collected via online and face-to-face focus groups and semi-structured interviews with key stakeholders, including pupils, parents/carers, Allied Health Professionals and school staff. Recruitment was supported by designated school contacts. Consent and assent were obtained using accessible formats. Discussions explored school food provision, dietary needs, and influencing factors. Sessions were recorded, transcribed, and analysed using thematic framework analysis. Data collection occurred between October 2024 and January 2025. Twelve focus groups and eleven interviews were conducted across four specialist schools. Stakeholders highlighted efforts to meet pupils’ individual mealtime requirements, though challenges with modified diet provision and accommodating sensory preferences were common. Menu accessibility, food variety, and communication about food intake varied. Staff and families collaborated to support pupils, but concerns about hunger, food quality, and FSM uptake persisted. Some schools reported poor availability of foods suitable for modification. Variable flexibility in food ordering led to challenges in meeting individual pupil needs and concerns about dietary sufficiency in some settings. Stakeholder menu planning involvement differed across schools and catering models. Awareness of School Food Standards was mixed, with financial and staffing constraints affecting implementation. Specialist school food provision must accommodate diverse pupil needs and comply with School Food Standards despite resource constraints. Challenges in meeting individual pupil needs contribute to low uptake of FSM among eligible pupils with potential negative impact on the nutritional quality of FSM and on service viability. Future specialist school food interventions co-created with all stakeholders will ensure the feasibility and acceptability of interventions which aim to deliver equitable access to healthy school food for all pupils.