The Health and Social Care Bill is set to continue its progress after the Government won two key votes in the House of Lords.

Peers voted 330 to 262 against an amendment to refer parts of the Bill to a special select committee and also rejected an amendment to block the legislation altogether.

Ministers say that the votes show the Bill now has wide spread support but the BMA has again called for it to be “withdrawn” or “substantially amended”.

A line by line examination of the Government’s controversial reforms will now begin in the House of Lords on 25 October. Labour has said it will again “fight” the proposals despite the outcome of the votes.

The amendment to block the Bill was put forward by Labour peer and former GP Lord Rea, who argued that it was never a manifesto by either the Conservatives or the Liberal Democrats. It was rejected 354 votes to 220.

Attempts to delay the progress of the Bill, which Lord Howe said my “prove fatal” to the NHS, were tabled by two crossbench peers, Lords Owen and Hennessy. The two called for its referral to a special select committee, which would have allowed witnesses and experts to provide evidence on the proposals after concerns were raised about the responsibility of the health secretary and the role of the NHS’ regulator Monitor in promoting competition.

A spokesman for the DH says decision by Lords “moves us one step closer to delivering a world-class health service that puts patients at its heart and hands more power to health professionals”.

But Andy Burnham, Labour’s recently appointed Shadow Health Secretary, says hearts “sunk around the NHS” when the Bill survived the votes and the Government is “digging in for the long haul” as it faces more opposition.

Doctors’ leader Dr Hamish Meldrum, Chairman of the BMA, says it continues to have concerns about “many areas” of the Bill and says the council will continue to raise its opposition “at every available opportunity”.

Dr Meldrum called for an assurance that patients’ choice of provider of care would not be given priority over the development of integrated services and fair access.

“We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services. In addition, we continue to have significant concerns over the arrangements for public health and education and training and we will be looking to see improvements made in these areas too.”

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The Health and Social Care Bill has cleared another political hurdle: the House of Lords has voted not to refer it to a select committee and not to block the Bill outright.

The Health Bill will now proceed to a normal House of Lords committee stage.

The BMA, who lobbied peers to reject the Bill, have continued to call for the Government’s NHS reform plan to be withdrawn or “substantially amended”.

The amendment calling for referral to a select committee, which would allow witnesses to give evidence, was tabled by cross-bench peers Lords Owen and Hennessy. They argued that aspect of the Bill raised serious constitutional issues – specifically in relation to the roles of the Health Secretary and the regulator, Monitor.

According to Lord Owen, a select committee was necessary to examine “the complexity of this new relationship” between patients, clinicians and the DH. He insisted that the select committee would not prevent the Bill completing its trajectory on schedule.

However, Health Minister Lord Howe denied that the market reforms threatened the integrity of the NHS, and claimed that any delay “could well prove fatal” to the necessary timing – as the changes are already under way.

The Lords voted 330 to 262 against the amendment. They also voted 354 to 220 against an amendment put forward by Labour peer Lord Rea to block the Bill on the grounds that it ran contrary to both Conservative and Liberal Democrat manifesto commitments.

Recently-appointed Shadow Health Secretary Andy Burnham said Labour would continue to oppose the Bill: “It will be debated now over a number of weeks, even months, in the House of Lords – line by line, clause by clause – and Labour will be wanting changes to this bill, substantial and drastic changes to it, so this is far from over.”

The BMA had written to every peer urging them to block the Health Bill as “dangerous”. PM David Cameron responded by claiming the Bill had the broad support of the medical profession, while Health Secretary Andrew Lansley claimed the critics were “politically motivated”. The BMA has rejected both claims.

Following the House of Lords vote, Dr Hamish Meldrum, Chairman of the BMA Council, commented: “The BMA continues to have many areas of concern, including the need for assurance that increasing patients’ choice of provider for specific elements of their care won’t be given priority over the development of integrated services and fair access. We also need to see an explicit provision that the Secretary of State will retain ultimate responsibility for the provision of comprehensive health services.”

Critics of the Health Bill claim that whereas the first version made privatisation of the NHS an overt political aim, the second version retains it as a covert goal and intended consequence of the legislation.

The Government aims for the Health and Social Care Bill to become law by April 2012, a year before the new Clinical Commissioning Groups are due to take charge of NHS budgets.

Protests are being planned ahead of the Health and Social Care Bill’s passage through Parliament next week.

UNISON and the BMA are planning to show their opposition to the controversial reforms to coincide with report stage and third reading of the Bill on the 6th and 7th September.

Local events nationwide are planned to coincide with Bill entering the House of Commons with NHS staff and patients set to gather for a candlelit vigil outside Parliament. The BMA is also urging campaigners to take part in online action to email their MP signalling their opposition, and to use Twitter and Facebook to voice their concerns.

BMA Council Chairman, Dr Hamish Meldrum, has also written to all MPs saying the reforms still present an “unacceptably high risk to the NHS” warning them it threatens its ability to operate “effectively and equitably, now and in the future”.

Despite the amendments following recommendations from the NHS Future Forum, the Association still believes the Bill should be withdrawn or be subject to further substantial changes.

In his letter, Dr Meldrum continues to warn of the “inappropriate and misguided reliance on ‘market forces’ to shape services” with the Bill creating “a more central role for choice without a full consideration of the consequences” and the “potential to destabilise local health economies”.

There are several specific areas of concern the BMA has on the Bill including:

• The limit Foundation Trusts (FTs) can generate from private patients
• The proposed ‘Quality Premium’ for commissioners
• Forcing all NHS Trusts to become FTs
• That the Bill reflects an intention that any increase in patients’ choice of providers should not be given a higher priority than tackling health inequalities and promoting integrated care
• Ensuring there is a robust and transparent process which has the full confidence of the profession when it comes to how ‘failing’ FTs are dealt with
• The lack of satisfactory assurance that the Secretary of State will have ultimate responsibility for the provision of a comprehensive health service whilst also allowing other bodies, like the new NHS Board and Clinical Commissioning Groups, day-to-day operational independence.

In a response to the concerns over the responsibility of the Secretary of State, the DH says “the Secretary of State will continue to be responsible - as now - for promoting a comprehensive health service. The NHS will always be available to all, free at the point of use and based on need and not on the ability to pay. To say otherwise is absolute nonsense”.