NICOLA Sturgeon has been forced to defend her government against accusations that the NHS in Scotland is already operating a "two-tier system" as MSPs heard that 40 per cent of all hip and knee surgeries carried out last year were private.

Both Douglas Ross and Anas Sarwar quizzed the SNP leader over leaked minutes of a top-level meeting of health service chiefs obtained by the BBC, which warned of a "billion pound hole" in their budget.

According to the report, executives are said to have expressed a view that "fundamental reform" of the primary care model "must be on the table", and that the success of the NHS has been built on a model "that no longer works today".

This reportedly led to a suggestion to "design in a two-tier system where the people who can afford to go private".

In his question to the First Minister, Mr Sarwar told MSPs that over 39,000 patients were treated privately in Scotland last year. 

“The number of people now paying for treatment without health insurance has increased by 72%. 

“Often these are people who are forced to borrow money, turn to family and friends or even remortgage their homes to get health care that should be free at the point of need. 

“So I know the First Minister doesn't like facts, but let's look at the facts. Almost 2,000 people have gone for private treatment for endoscopy and colonoscopy. Privately these treatments cost an average of £1,195. 

“Over 7,800 people have gone private for a cataract surgery, average cost of £2,660, and a staggering 3,500 have had a hip or knee replacement, a private hospital average cost of £12,500. 

“These figures make clear that under the SNP health care in Scotland is already a two-tier system. So does the First Minister accept that this goes against the founding principles of our NHS, a universal health care system free at the point of need?” 

Ms Sturgeon told the Labour leader that she did not accept that. 

“We will always act to protect the founding principles and we've done more than any other government to achieve that.

"And the one thing that was missing completely from Anas Sarwar’s question there, of course, was reference to a global pandemic that caused the cancellation and the pausing of elected services in our National Health Service for a considerable period of time.”

Mr Sarwar said the pandemic was not a “good enough excuse.”

“The First Minister denies we have a two-tier system. In 2021, 40% of all hip and knee replacements that happen in Scotland were paid for privately. 40%. That's 3,430 people paying privately to get a hip or knee replacement. 

“Our NHS is at risk because of this government's choices and this government's crisis.”

The First Minister said she agreed that the pandemic should not be used as an excuse, “but nor can it be ignored in terms of the impact on our National Health Service.”

Earlier, responding to a question from Mr Ross, the First Minister said the number of people who self-fund for private care in Scotland was far lower per head than in England and Wales. 

“Let's look at NHS use of the private sector,” she added. “In Scotland, total spend on use of the independent sector represents 0.5% of the total frontline health budget. In England, where the Conservatives are in power, that figure is almost 7%, £12.2bn. 

“This government will take no lessons from the Conservatives when it comes to privatising the National Health Service. In fact, presiding officer, this government will take no lessons from the conservatives on the NHS full stop.” 

Mr Ross pointed out that because of the EIS strikes over pay, “sadly in Sturgeon's Scotland, no one is getting any lessons today."

He said that private treatments in Scotland have increased by 84%. In the rest of United Kingdom, the increase has been 39%. 

The Tory leader said someone had given the “green light” to the NHS directors to have this discussion otherwise it would mean they were “going off to try and fix the NHS on their own with no government oversight.” 

“So is this not just another confirmation that Hamza Yousef is out of control with Scotland NHS?” he asked. 

The First Minister disagreed. “NHS leaders are entitled to discuss what they want. They do not make government policy, the government makes government policy. And I could not be clearer about that.”