Liberal Democrats packed the main hall of the party conference in Birmingham for a debate on NHS reform on Tuesday, where some members attacked the controversial Health and Social Care Bill.
A heated debate on NHS reform at the party's Spring conference in Sheffield put pressure on Health Minister Andrew Lansley's original Bill, which was then overhauled following a 'listening exercise'.
Two thirds of the Lib Dem MPs who are not ministers or in government rebelled in September when the Bill was voted on by the Commons.
And while most members were restrained in their criticism, there were some signs of tension at this year's conference.
The first question asked - "Has the government got NHS reform right?" - received laughter from delegates.
Baroness Shirley Williams also received applause when she criticised the bill, asking why the changes to the NHS couldn't have been made without the "agony" of the legislative process.
"Why we've got 440 pages of totally obscure legislation I simply don't understand," she said. "What was the point of all that? Why have we gone through such agony?"
Williams said that the bill would be scrutinised in the House of Lords "in vast detail" over 10 to 12 days, and could potentially be delayed unless there were further concessions.
Backbench LibDem MP John Pugh, who has been a frequent critic of the Health Bill, also won applause when he said that while the bill had been "substantially improved by the Liberal Democrats" it still represented "a huge mistake" for the party and the government.
Pugh likened his feelings about the bill to the "sinking feeling" of missing an exit on a motorway and knowing that "it will be some time before you get on the right track again".
"We have repeated the mistake that previous governments have made and have not built on what was good about the past," he said.
The current bill was defended by Paul Burstow MP, who said that the majority of the proposals were in the coalition agreement.
"Don't just stop reading when you get to the bit you like, read some of the things you don't like," he told delegates. "They were there and that's why they are in the bill."
"We didn't stop listening when the listening exercise ended," Burstow said, adding that he expected the bill's passage through the Lords to improve the bill "which is exactly what it should do".