In this article, Hazel Lawson, principal lecturer in education at the University of Plymouth, Sue Waite, a researcher at the University of Plymouth, and Christopher Robertson, lecturer in special and inclusive education at the University of Birmingham, discuss the curriculum for students with severe and profound and multiple learning difficulties at ages 14 to 16. This phase of schooling, referred to as Key Stage 4 in the English system, is characterised, in mainstream settings, by examination processes. Drawing upon research work carried out for the Qualifications and Curriculum Authority, they argue that developing a distinctive curriculum offer for students with severe and profound and multiple learning difficulties in Key Stage 4 presents both opportunities and challenges. Setting their argument in the context of current proposals for the reform of education between the ages of 14 and 19 in England, they highlight issues including the desire to maintain breadth and balance while meeting individual needs and preferences; progression towards more facilitative pedagogies and a diversity of contexts for learning; and tensions between providing continuity and introducing change intended to promote increased student autonomy. This article will be of direct interest to policy makers and practitioners in mainstream and specialist settings.