Building on remarkable and sudden fundraising success during the Covid-19 pandemic, many National Health Service (NHS) charities in England and Wales have undergone a period of rapid organisational transformation and growth. This article explores these developments by considering how claims to distinction contribute to new organisational identities and allow access to valuable resources and funding opportunities. After situating recent developments within the policy background and key changes in governance and regulation since the 1990s, we report on interviews with directors and trustees of NHS Charities Together (NHSCT), the national membership organisation of NHS charities. These offer new insight into strategic shifts and the desire to form a distinct and unified identity for NHS charities. Highlighting ongoing tensions and debates within the sector, findings raise important questions over the role of NHS charities and their position in relation to the NHS and the state.