A €50 CHARGE on medical cards, a €1.50 increase in prescription charges and widespread nursing home closures are now among swingeing Budget measures being considered by the Cabinet.

The stark measures were outlined by Health Minister James Reilly last night in a series of detailed briefings to Fine Gael and Labour TDs.

The nuclear options, which were leaked to the media within a short period, are seen by analysts as a shot across the bows before Budget 2012 in two weeks.

Sources said that it was felt Dr Reilly was presenting the worst possible options so that the final cuts would not seem so bad, or was attempting to secure more room to manoeuvre on the health budget from his Cabinet colleagues.

Any charge on medical cards would be potentially explosive as the previous government found out when it tried to take away automatic entitlement for the over-70s.

And there are serious differences among senior ministers -- with tensions mounting between Fine Gael and Labour -- over where the axe should fall between social welfare and health.

Sources said Public Expenditure Minister Brendan Howlin is hoping to front-load the health cuts in what is the second biggest spending area after social welfare, with a figure of €500m in savings mentioned.

However, it is understood Dr Reilly favours spreading the cuts out over a longer period of three or four years.

Fine Gael TDs last night weighed heavily in behind Dr Reilly, with one deputy describing the cuts outlined as "horrific, terrible, awful".

Among the cuts being discussed are:

- A €50 annual charge on medical cards, which are currently free.

- A €1.50-per-item increase in prescription charges from 50c to €2 for those on medical cards.

- The closure of as many as 40 nursing homes because of a cut of 842 long-stay beds.

- Shelving proposals to provide free medical care to those claiming free drugs under a long-term illness scheme.

- Significant cuts in the level of home help.

- As much as €35m less for the long-delayed mental health strategy.

A breakdown of the closure of long-term beds in nursing homes by Dr Reilly shows that 293 may go in the Dublin-Mid Leinster HSE region; 208 in Dublin North-East; 212 in HSE West and 129 in HSE South.

Fine Gael TDs last night described the cuts as "draconian" and said Mr Howlin was asking Dr Reilly to cut too much too fast.

They expressed concern that nursing home closures could pile pressure on already stretched hospitals.

The proposal to tax medical cards could provoke uproar, and the Fianna Fail-Green Party coalition was rocked in 2009 by its move to withdraw an automatic entitlement to the card for the over-70s.

More than 1.5 million people are now covered by medical cards, which entitle patients to free GP care and drug costs.

Reluctant

Dr Reilly is said to be extremely reluctant to tax medical cards or increase prescription charges.

As recently as March 16 -- when he was just a week in office -- he promised to scrap the 50c charge, saying it was preventing people getting their medicines. The latest proposals include quadrupling the charge.

Dr Reilly briefed the Labour parliamentary party and a meeting of the Fine Gael internal health committee, which was attended by around 30 TDs, at two separate meetings yesterday.

He told TDs that already stretched hospitals around the country would be put under even more pressure by the proposed cuts in long-term bed numbers.

"You'd clog up the hospital system," one TD said after the discussions.

"It's all very unpalatable, he needs to be given more time to do it," another Fine Gael TD said. "He needs more time to spread it out."

Taoiseach Enda Kenny said the Government was coming to the end of its discussions on the Budget but admitted some ministers had "views" on specific issues.

"Tomorrow, we have to continue our discussions about adjustments for the Budget and I hope that we can conclude matters," he said.

It comes after Social Protection Minister Joan Burton said cuts to child benefit were on the cards, with a flat €10 across-the-board reduction mentioned, and an €8 cut to the dole.

Oireachtas health committee chair Jerry Buttimer said the planned reforms of the health service could not be carried out with this level of cuts.

Irish Independent