I wish to raise the ongoing need for consultation with communities which are hosting persons with temporary protection and international protection applicants. I want to give an example, which is the area where I come from and where I live, east Clare. Soon after the outbreak of the war in Ukraine last year, 40 Ukrainians arrived in Flagmount. Earlier this year, the east Clare holiday village was repurposed and 220 arrived. Very recently, the former hotel in Scarriff was repurposed and is taking up to 75 asylum seekers. Throughout that time the medical centre in Scarriff that serves all of those areas has received no communication whatsoever from either international protection accommodation services, IPAS, or the HSE with regard to this. The Taoiseach will know that medical centres across Ireland generally, and particularly in rural Ireland, are under pressure. There are more GPs retiring than coming through for rural practice. There are difficulties around that. They obviously want to provide a service to everybody in their community, both people who have been there for a long time and people who have recently arrived. We simply cannot pretend that new people arriving does not create additional pressures in a community. It does. If people do not speak English fluently, or at all in some instances, it will create additional difficulties in that consultation periods are longer. I am not saying that IPAS can arrive with a new GP because people are being housed. I am not expecting the impossible but communities are entitled to know what the plan to develop services is because nobody is expecting the war to end tomorrow. Nobody is expecting immigration to end tomorrow. What is the plan or is there a plan?

I am not looking to blame anybody here but we need an all-of-government approach because we need to make sure that the people who are coming are integrated and receive the services they require, just as we need to make sure there is not a reduction or diminution in services in the communities which are receiving them. That would be profoundly unfair. Obviously, there is a disparity across the country with some areas receiving far more than others and some areas with the capacity to take more than others. There is a disparity and that needs to be matched with resources. Yes, the Minister, Deputy Humphreys, has moneys but it needs to be more profound than just arriving with a chequebook because arriving with a chequebook will not provide additional medical services where they are needed. Arriving with a chequebook will not provide the teaching of the English language to foreign students as a speciality because these are specialist services. I am not saying the Government should be able to provide those services instantly but there has to be a plan and communities are entitled to know what that plan is.

I thank the Deputy for his measured approach and for the very reasonable questions he asked. It is important we talk about this issue but in a considered way. We should never lose sight of the fact that what we are experiencing across Europe is the worst refugee crisis since the 1940s. Some 4 million people have been displaced from their homes in Ukraine and roughly 2% of them have come to Ireland, which is approximately 80,000 people. Of course, in addition to that people from the Balkans and outside of the European Union are seeking international protection, some of whom come to Ireland. That has created an enormous challenge for us. We have had to find accommodation for approximately 100,000 people in the past year or so, and we have. It might not always be the kind of accommodation that we want but we have been able to provide shelter, food, accommodation, education and healthcare for nearly 100,000 additional people in the past year. I think when history looks back on that period it will reflect well on us, not so much as a Government but as a country, that we were able to take in 100,000 people who were fleeing war and seeking international protection.

I want to acknowledge in particular the very real welcome people in County Clare have given people coming from Ukraine and for that reason €3 million was allocated to County Clare as part of the community recognition fund. But it does create pressures on schools and on GP services. When it comes to schools, heroic work has been done by the Minister, Deputy Foley, by the Department of Education and by teachers and principals. There are now 14,000 Ukrainian children in Irish schools who are generally doing very well. They are learning English, making friends and becoming part of the community. In my view, that is a big achievement. Yes, it has put pressure on GP services. When I was a practising GP one of my jobs was to go to a clinic once a week and look after the health needs of newly arrived asylum seekers in Kilmacud at the time. It is tough because the consultation takes two or three times as long as it would with an Irish person because of language difficulties, the need for a translator, and even cultural differences in how people describe their symptoms. That makes that consultation two or three times longer and puts huge pressure on GPs. There is not a quick fix to it but the kind of things we are doing, other than of course providing medical cards for people who need them who are coming to Ireland from Ukraine and elsewhere, is increasing the number of GPs we are training. That will be up to 300 per year quite soon, which is a doubling of the number of GPs we train every year. We are examining a very interesting proposal from the University of Galway to establish a new graduate entry programme into medical school for those who live in rural Ireland and who want to do remote and rural medicine. That would create a dedicated stream of people who are a little bit older going into medical school, who want to stay in Ireland and who particularly want to engage in remote and rural medicine. The University of Galway has a really interesting proposal in that regard but it does take time from when we start training people now for them to be available.

It does take time and I am glad the Taoiseach acknowledges there is a problem. We need to go further than acknowledging there is a problem and maybe establish a liaison between the HSE and IPAS. I am not blaming IPAS and I am not blaming the Ministers, who are both sitting there, at all but we do need a whole-of-government approach because what we cannot have is service providers, in particular vital services like GPs, having to choose between providing a service to their existing patients or maybe the growing families of existing patients, and new patients who are coming in. That will create division and resentment, and understandable resentment, and we just cannot have that.

During the recess we learned of difficulties in the work permit system around healthcare professionals. I appreciate it is slightly different but it goes back to what Deputy Grealish raised. We also need a vast improvement in the work permit regime. There are people who have been granted work permits being refused visas, and there are a lot of them, by the Department of Justice. There seems to be a disconnect between the two regimes. There are two separate statutory regimes and the Government really needs to look at that.

The question I raised is around making sure that there is a plan for areas that are accepting persons seeking international protection and those who have temporary protection, and that plan is clearly communicated to those communities.

We have a Cabinet sub-committee on Ukraine and migration. I chair that sub-committee and health is part of that. A pretty regular agenda item we discuss is the health impact and health needs of people who have come here from abroad.

That does not get down to the communities.

That is a fair point and something I will follow up on because the situation in each community is different depending on the needs and the capacity of the community and the profile of the people we are bringing into that area. One thing that can help is registering Ukrainian doctors and nurses. They have come to Ireland as well. Making sure their qualifications are recognised, allowing them to work in our health service and getting around the issues of translation is being done. The other work that is being done is bringing together the work permit and visa systems in a single combined system. That is a European law that we have opted in to. I know from experience that we turn around work permits very quickly now, in two or three weeks.

Visas are a little more complicated because we have to check that people are who they say they are. Often, the delay in issuing a visa to somebody is not a delay on our side. It is a delay in the police department in the country they are coming from, because we need to check that they are who they say they are. Nobody would forgive us for issuing visas to people without due diligence.