At a campaign event in Glasgow on Tuesday, Sarwar was challenged on research from Professor Allyson Pollock which compared the English and Scottish health services over two decades and found that the use of private firms to deliver NHS services had resulted in “clear evidence of a two-tier system now operating within the NHS in England”.

In Scotland the focus had been on increasing in-house NHS capacity rather than outsourcing to private providers, and the study found this meant inequality had worsened “at two-and-a-half times the rate in England than in Scotland”.

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Pollock, a clinical professor of public health at Newcastle University, said that the use of private healthcare capacity in the NHS was also making it harder to train the next generation of doctors – pointing to particular concerns from the Royal College of Ophthalmologists about cataract surgeries.

“It’s a very bad idea,” she told the Sunday National. “It’s bad for patients. It’s bad for medicine. It’s bad for care – and it’s bad for the public purse.”

Asked about Pollock’s study after Scottish Labour refused to respond to its findings, Sarwar said a two-tier NHS system was “like we have in Scotland right now”.

Pushed on the study’s findings, he repeated: “Like what’s happening in Scotland right now.”

Scottish Labour leader Anas Sarwar dressed up a dentist for a photo shoot (Image: PA)

He went on: “What I’m saying to you is, you live in Scotland, and the real world in Scotland is that record numbers of people are going private to get treatment.

“There are people in our country right now who are paying £12,000 to get a hip replacement, £8000 to get a knee replacement, £5000 to get a cataract.

“The answer to that is not to keep the same people in power that have driven our NHS into being a two-tier system.

“My answer to that is to get rid of the SNP, not be cheerleaders for that.”

Asked whether he would reconsider his policy of using private services in Scotland’s NHS in the wake of the evidence from the survey, Sarwar said: “I’m engaging about what’s happening in Scotland and I’m looking at the evidence and the record of an SNP Government, which I’m not willing to see continue in Scotland.

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“So if you want to fix the NHS, if you want to stop the two-tier system in Scotland, and if you want an NHS that survives in Scotland and returns to its founding principles, that means removing the SNP from power and voting for Scottish Labour on Thursday.”

Sarwar has repeatedly said a Labour government in Edinburgh would use private capacity to deliver NHS services, with his party’s election manifesto pledging to deploy “all available capacity no matter where it is, even if that is elsewhere in the UK or it means purchasing capacity from the independent sector on a short-term basis”.

Elsewhere, Sarwar denied suggestions that he had backed suggestions from Dr David Offord – a dentist who runs Vermilion, a firm with private dental clinics in Edinburgh and Kelso – that NHS Scotland should not provide certain services such as crowns and orthodontics.

Offord had suggested shifting such services entirely onto private practices, leaving the NHS to focus on prevention.

Scottish Dental Magazine reported that Sarwar had “wholeheartedly agreed with Dr Offord that the balance must shift toward preventative care”.

An image showing Dr David Offord (centre, left) and Anas Sarwar (centre, right) at the Vermilion Biennial Symposium dental conference (Image: Vermilion/LinkedIn)

Asked if he agreed with Offord that NHS Scotland should stop providing certain dental services, Sarwar said: “That’s not what happened. The wholehearted agreement was the fact that we have a broken system right now where we have a two-tier dental service.

“Right now, there’ll be people phoning a dental practice and they’re being told, ‘if you’re willing to go private, we can see you next week or we can see you in days, but if you want to wait on the NHS, we can see you in three weeks or four weeks’.

“That is a two-tier NHS and NHS dentistry, and I wholeheartedly agree that needs to end.”

He went on: “In actual fact, we’ve seen a partial privatisation of orthodontics by the SNP.

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“If you look historically, what they have done is they’ve changed … what then makes you eligible for free orthodontics, that criteria narrowed under the SNP rather than widened.

“They in many parts privatised orthodontics as well as many of the treatments that you get in broader NHS dentistry.

“I don’t think that is fair. The reality is, Nicola Sturgeon, when she made that change, if she had a missing front tooth, she wouldn’t have been First Minister.

“That’s part of the challenge is someone’s oral health, someone’s visual appearance does impact on their confidence.

“It does impact on their accessibility to skills, it does impact on their broader life, and that’s why having a quality dental service that is more than just about filling the holes, but is also about building confidence is crucial to getting better outcomes for people across the country.”