Lords have voted down two amendments which would delay or halt the government's NHS reforms.
The health and social care bill will now a second reading after an amendment by Labour peer and former GP Lord Rea to halt the bill altogether was voted down.
Rea told the House: "Whole swathes of senior members of my profession want this bill sent back the drawing board.", adding that the Bill should be blocked so "the NHS can get back to work without a Sword of Damacles hanging over it".
And they rejected a separate amendment by Lord Owen which would send the Bill back to a committee, halting its progress by 68 votes, with 262 voting for it and 330 against.
Conservative health minister Lord Howe ended the Lord's debate on the NHS reforms with a final plea for Lord Owen's amendment not to be carried, saying it would cause damage. He added: "The NHS needs continual renewal. It has never stood still, and it cannot stand still now."
Christina McAnea, Head of Health, at trade union Unison said they were "bitterly disappointed": “Too many Lords failed to listen to the groundswell of opposition from the public, health professionals, charities, staff and unions to the dangers of the Health and Social Care Bill. It was a missed opportunity. Everyone was counting on them to rescue the NHS from the worst of the Tories’ excesses – and they have let them down."
And shadow health secretary Andy Burnham said opposition to the Bill remained "formidable": "The sad thing for me is that the opinion of the country is obvious. GPs don’t want the Bill, we have child health experts coming out today saying they don’t believe the Bill will make services better for children. The consensus is overwhelmingly against this bill and I think it is very sad that the House of Lords didn’t listen to it", he told the BBC.
On Tuesday Howe distributed a last-minute letter to Lords warning against two peers' attempts to have the bill send to committee on Tuesday morning. He outlined concessions the government were willing to make, saying that while it was "unequivocally clear" that health secretary Andrew Lansley still had ultimate responsibility for the NHS under the legislation, they were willing to make this more explicit.
During the debate Labour peer Baroness Thornton warned the government had shown "breathtaking disregard for the democratic process". She also reminded Liberal Democrat peers of their reputation for protecting the NHS, warning them not to put that legacy in "jeopardy"
Thornton added that the government had "no mandate, no evidence and no support" and warned the bill would turn getting NHS care into "shopping".
Medical organisations have united in opposition to the changes, which will dissolve primary care trusts (PCTs).
Opponents of the reforms argue they will allow private patients to leapfrog to the front of queues for surgery, open the NHS up to competition and create a new and complex layer of quangos to replaces PCTs.
The Chairman of the Academy of Medical Royal Colleges, Professor Sir Neil Douglas, has expressed serious concern about the NHS reforms, saying the Bill could "damage patient care".
And the BMA has written to every peer in the Lords outlining their concerns about the Bill.
London university academics have also written to medical journal the Lancet saying are the reforms "fundamentally flawed".