Nurses have passed a motion of no confidence in health secretary Andrew Lansley.
The majority (99%) of delegates at the Royal College of Nursing (RCN) conference in Liverpool voted for the motion.
They believe his plans to reform the NHS would ruin the service and lead to worse patient care.
Mr Lansley has been heavily criticised for refusing to deliver a speech to the conference.
Instead, he will meet a group of around 60 nurses in Liverpool as part of the government's "listening exercise" on the controversial reforms.
The government has said it will use a "pause" in the passage of the Health and Social Care Bill to listen to concerns about the plans.
Other unions, including the British Medical Association, have condemned parts of the Bill, as have patient groups, royal colleges and MPs from various political parties.
Never before has the RCN voted on a motion of no confidence in a health secretary.
After the vote, Mr 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 £11.5 billion into the service."
Copyright © Press Association 2011
We asked if you agree with the vote. Your comments (terms and conditions apply):
"The vote expresses nurses' frustration at not being able to deliver acceptable care for all their patients. It's easy to blame the Health Secretary but perhaps we should also be asking where was the voice of the RCN when the health bill was being prepared? We should also ask why the RCN has been quiet about supporting the excellent evidence in the Commission on Nursing published just a year ago? It's not too late to do
this" - Catherine Gleeson, West Yorkshire
"GPs are not accountants. They should concentrate on patient care in conjunction with the nurses. Without the mixed skills of nursing teams, primary care would fall apart" - Name and address supplied
"I totally agree with the majority votes, Margaret Thatcher's reign in government is responsible for the damage to the NHS, Mr Lansley and the present government is going to destruct it further" - F Sturdy, Northumberland
"Yes I do!" - Patricia Mthimkulu, Herts
"Yes, furthermore, Mr Lansley and his colleagues should remember that the NHS could not function without nurses, regardless of how many doctors it employs" - Felicia Salmon, Ealing
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