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Nurses attending their annual conference have voted overwhelmingly in favour of a motion saying they have "no confidence" in the health secretary's proposed reforms of the NHS.
At the Royal College of Nursing (RCN) conference in Liverpool, delegates voted four hundred and seventy eight in favour of the vote with just six against.
It is the first time the RCN has voted on a motion of no confidence in a health secretary.
Nurses said Andrew Lansley's plans would ruin the health service and lead to worse standards of patient care in England.
The government has said there will be a chance to "pause" and make substantive amendments to the Health and Social Care Bill as it goes before Parliament.
Under the plans, GPs will be responsible for commissioning most services, while greater competition with the private sector will be encouraged.
Labour leader Ed Miliband accused the government of putting the NHS at risk and said the prime minister should take charge and drop the bill.
He said: "The answer to a bad bill is not to slow it down, but to junk it.
"This is a bill which starts with a wrong-headed ideology and has a whole series of proposals which haven't been thought through."
Lansley was heavily criticised for refusing to address the conference.
He instead opted to hold a 45-minute Q&A with 60 nurses as part of the government's "listening exercise" on the controversial NHS reforms.
Following the vote, Lansley said: "The nurses' union support the principles of the Bill.
"But I know from listening to them that they want further nurse involvement in decisions. So do I.
"And I understand their concerns. We are listening to nurses and will make improvements.
"There isn't an option to do nothing if we want to sustain the NHS for future generations.
"Any government would be faced with the same challenges, only it would have been far worse under Labour because they wanted to cut the NHS budget, whereas we are investing an extra £11.5bn into the service."
Shadow health secretary John Healey said: "Nurses have confirmed today that the health secretary has lost the confidence of the NHS.
"But the real test now is for the prime minister on whether he will make the root and branch changes needed to his reorganisation plans for the health service."
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