Nicola Sturgeon clashed with Douglas Ross during a fiery debate in the Scottish Parliament over the future of the health system.
The Scottish Conservative leader attacked the First Minister over reports that NHS chiefs had discussed making wealthy Scots pay for treatment in a "two-tier system".
Ross accused the SNP leader of privatising parts of the health service in Scotland - while she hit back highlighting his record as MP for Moray.
It comes after a leaked report revealed senior NHS bosses has previously discussed what measures could be taken to ease the pressure on the health service. T
The meeting reportedly criticised the government - with the group having "concern" about the alleged lack of clinical input into political decision making.
Draft minutes of an executive-level meeting in September were leaked to BBC Scotland and show the introduction of a "two-tier" system was one item discussed.
Ross highlighted the meeting during FMQs today, he said: "The First Minister is in denial about how badly her health secretary is handling the NHS crisis. In denial about the scale of privatisation that’s happening on her watch.
"In denial about Humza Yousaf’s two-tier system that’s already becoming the norm in Scotland. She has become so distracted, focusing on her own political priorities, that she no longer realises how bad the situation has got here in Scotland.
"The minutes of this meeting of NHS chiefs claim there is a disconnect between what’s happening on the frontline and what the health secretary thinks is happening. They accuse Humza Yousaf of being ‘divorced from reality.’ They’re right, aren’t they, First Minister?"
Sturgeon hit back saying Ross "doesn't stand up for the principles of the National Health Service".
She said: "Last year, there was an amendment passed in the House of Lords that would have explicitly protected the NHS and excluded it from trade deals that could undermine its founding principles.
"Tory MPs in the House of Commons voted to remove this protection. Guess who one of those Tory MPs was, presiding officer? Douglas Ross. Even when he gets the chance he doesn't stand up for the principles of the National Health Service. This government, always will."
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