Despite having terms of reference that include crucial issues like adoption practices and vaccine trials, its focus in that time has been almost exclusively on one institution — Tuam, and one issue — infant deaths.

This may be by accident or design but, either way, it suits the Government. It keeps the narrative focused on historic deaths in an institution in the west of Ireland and away from a key issue — the huge and glaring elephant in the room that no one likes to mention — the scale of forced and illegal adoptions and the State’s role in same.

The irony of all of this is that an inquiry into all of these matters could have happened long before the Mother and Baby Homes Commission was set up in 2015. Like the Magdalene laundries inquiry before it, the Government was dragged kicking and screaming into an investigation.

The research of Catherine Corless relating to infant deaths at the Tuam Mother and Baby Home and the subsequent international media attention the story generated forced the Government to examine these institutions.

We have since learned, through numerous revelations in this newspaper, that the State was well aware of these issues long before Tuam hit the headlines in 2012.

Indeed, calls for an inquiry into how thousands of adoptions have been contracted across decades have been bouncing around since the 1990s. Every government since then has told activists that there is nothing to see here — despite mountains of evidence stating otherwise.

So three years into the inquiry, what has been the progress of the Mother and Baby Homes Commission? In a word — slow.

That was to be expected. No one with a grasp of the scale of the task facing the Commission expected it to issue its final report by the initial deadline of February 2018. It will now issue its final report in February of next year.

However, given it has just recently moved its focus away from Tuam to examining another institution — Bessborough Mother and Baby Home in Cork — this also looks ambitious.

The Commission was established in February 2015. From then until July 2016, very little emerged as to its progress or how it operated.

In that time, a number of investigations by this newspaper revealed that both Tuam and Bessborough had been examined by the HSE prior to Catherine Corless’ revelations.

Senior management in that organisation, as well as two government departments — the Department of Children and Youth Affairs and the Department of Health — had been made aware of serious concerns raised about practices in at least one of these institutions.

In June 2015, just four months after the Commission was set up, the Irish Examiner revealed that two separate reports on Tuam and Bessborough were prepared by the HSE, while it was preparing material for the McAleese investigation into Magdalene laundries.

These reports not only explicitly reference infant mortality rates, but also expressed serious concerns about the possible trafficking of children from the institutions. They also mention that these issues needed to be investigated as a matter of urgency.

In the case of Tuam, a note of a teleconference call on October 12, 2012, revealed that senior management in the HSE felt what had been discovered needed to go to the minister so that warranted a state inquiry.

The call involved then assistant director of the Children and Family Service at the HSE, Phil Garland, and then head of the medical intelligence unit, Davida De La Harpe.

During the call, concern was expressed that as many as 1,000 children may have been trafficked from the Tuam Mother and Baby Home in what could “prove to be a scandal that dwarfs other, more recent issues with the Church and State”.

These concerns had been raised by the principal social worker for adoption in HSE West, who had found “a large archive of photographs, documentation, and correspondence relating to children sent for adoption to the USA” and “documentation in relation to discharges and admissions to psychiatric institutions in the Western area”.

The archive contained letters from the Tuam Mother and Baby Home to parents, asking for money for the upkeep of their children, and notes that the duration of stay for children might have been prolonged by the order for financial reasons. It also contained letters to parents asking for money for the upkeep of some children who had already been discharged or who had died.

The social worker, “working in her own time and on her own dollar”, had compiled a list of “up to 1,000 names”, but said it was “not clear yet whether all of these relate to the ongoing examination of the Magdalene system, or whether they relate to the adoption of children by parents, possibly in the USA”.

Those on the conference call raise the possibility that if there is evidence of trafficking, “it must have been facilitated by doctors, social workers, etc, and a number of these health professionals may still be working in the system”.

The note concludes by stating that, due to the gravity of what was being found, an “early warning letter” be written to the national director of the HSE’s quality and patient safety division, Philip Crowley, suggesting “that this goes all the way up to the minister”.

“It is more important to send this up to the minister as soon as possible: with a view to an inter-departmental committee and a fully fledged, fully resourced forensic investigation and state inquiry,” concludes the note.

At the time, the Department of Children and Youth Affairs (DCYA) denied this information was ever forwarded to the then minister Frances Fitzgerald.

A week later, in a separate report sent by Mr Garland to Mr Crowley, and which CC’d then national director of Children and Family Services, Gordon Jeyes, and Ms De la Harpe, Dr Declan McKeown, of the medical intelligence unit, also outlined concerns about death rates at both Tuam and Bessborough.

Dr McKeown notes that the infant mortality rate for Tuam was “approximately 20%-25%, similar to that recorded in Bessborough”. He also raised questions as to the veracity of such death rates.

“Queries over the veracity of the records are suggested by causes of death such as ‘marasmus’ in a two-and-a-half-month-old infant; or ‘pernicious anaemia’ in a four-month-old. These diagnoses would be extremely unusual in children so young, even with the reduced nutrition of the time,” he said.

A separate report into Bessborough not only revealed that the deaths of hundreds of children were recorded in the order’s own register which was handed over to the HSE in 2011, but that, similar to Tuam, the operation was aimed at making money. This report was seen by both the DCYA and the Department of Health yet no action was taken on foot of the concerns.

It is understood that these revelations and what was known by key personnel within the HSE prior to the 2014 revelations is currently being examined by the Commission.

However, throughout 2015, there was no word emanating from the Commission as to the progress it was making. Indeed, even the most rudimentary of press queries were met with terse responses.

In August 2015, the Commission declined to answer any questions as to how its Confidential Committee — set up to gather testimony from survivors — operates.

The Irish Examiner asked a series of questions:

• Will all interviews with the Confidential Committee be recorded, unless a witness does not consent to this?
• Will a transcript and audio copy of the recording be provided to the witness?
• What is the area of expertise of the experienced person taking notes when a witness is being interviewed?
• Will a copy of those notes be sent to the witness?
• Will the witness have an opportunity to clarify anything s/he believes does not reflect her/his testimony?
• Will witnesses be given a copy of the general report of the Confidential Committee?

However, a statement issued by Commission director Ita Mangan simply said: “All aspects of the Confidential Committee are confidential including its procedures. People who wish to be heard by the committee are given detailed information in advance about how the meeting will be conducted.”

In fact, some information on this Committee was one aspect dealt with when the Commission finally published some information on its progress in July 2016 — well over a year after it was set up. The Commission’s first interim report ran to just five pages and was primarily a request to extend the timeframe for the completion of its Confidential Committee report and its Social History Report. These were due to be submitted in August 2017.

The Commission asked for these to now be submitted along with the overall final report in February 2018.

At the end of September, the Commission announced it was carrying out a test excavation at the site of the children’s burial ground for the Tuam Mother and Baby Home. Site work began in October and was expected to last five weeks.

Then on 3 March, 2017, and somewhat out of the blue, the Commission dropped a bombshell that thrust Tuam back into the worldwide media glare. It confirmed that “significant quantities of human remains” had been discovered in at least 17 of the 20 underground chambers which were examined as part of the excavation works.

The Commission said it was “shocked” by the discovery and that it was continuing its investigation into who was “responsible for the disposal of human remains in this way”.

It requested that the relevant State authorities take responsibility for the “appropriate treatment of the remains” and notified the coroner.

In response, Children’s Minister Katherine Zappone said the coroner for north Galway would take the steps he deemed necessary and stated that Galway County Council would engage with the Commission in relation to the next steps to be taken at the site.

In June, Ms Zappone commissioned an Expert Technical Group (ETG) to outline to Government as to what options were available in terms of managing the burial ground.

Almost a year and a half year later, there has still been no decision made as to what to do with the site.

The reason for the delay is clear. Given it is known, and indeed the State has held the evidence since at least 2011, that similarly high infant mortality rates were prevalent in other mother and baby homes — most notably Bessborough — it would appear that any decision taken at Tuam will have to be replicated in other sites of suspected infant burials.

Delays were also attached to the publication of the Commission’s second interim report.

Completed in September 2016, it was not published by the DCYA until April 2017 — one month after the discovery of infant remains in Tuam.

Running to 16 pages, the report has three main sections — on redress, its terms of reference, and on the issue of the false registration of births.

The Government managed to get its message out ahead of the second interim report’s publication, when the Irish Times reported in advance of its publication the Government’s view that it “not possible” to implement the report’s main recommendation that the 2002 Residential Institutions Redress Scheme be reopened in order to compensate those who were in mother and baby homes as children.

The report stated that the Government should re-examine the exclusion of children who lived without their mothers in mother and baby and county homes from the 2002 scheme and that “other redress options” for those involved.

It stated that former residents of the Bethany Home and other mother and baby homes like Bessborough, Sean Ross Abbey, Castlepollard, Tuam and Dunboyne all had “a strong case” that they should have been included in the 2002 scheme.

“It is clear to the Commission, from its work to date, that the decisions on which institutions to include in, or exclude from, the redress scheme are not consistent,” stated the report.

However, the Government had already got its point across that this option was out of the question. It was repeated by Ms Zappone on the day of publication. The Commission had not yet made any findings to date regarding “regarding abuse or neglect” and it “would not be appropriate” to deal with the question of redress in advance of the final report, she said.

Indeed, successive governments have been aware that the thorny issue of redress for mother and baby homes would arrive some day.

The Irish Examiner revealed in March 2017 that concerns were expressed at Cabinet as far back as 2011 that, if there was an inquiry into Magdalene laundries, it could lead to calls for inquiries into abuses in mother and baby homes, psychiatric institutions, and foster care settings.

The concerns are in a memorandum for Government seeking permission to establish what became the McAleese committee.

The observations of the then minister for education and skills Ruairí Quinn state that, although he was supportive of the approach outlined in the memorandum, “there may be demands for enquiries [sic] into other situations”.

“Following the publication of the ‘Report of the Commission to Inquire into Child Abuse (the Ryan Report)’, there were renewed demands for the Redress Scheme to be extended to include other institutions, such as Magdalene laundries, mother and baby homes, psychiatric hospitals and foster care settings,” he said.

It went on to state that, while Mr Quinn recognised the demands being made on behalf of the women who had been through Magdalene laundries were for a separate redress scheme, “he is conscious of the implications of any move towards redress, for the Residential Insititutions Redress Scheme”.

The Commission’s second interim report acknowledged calls for an extension of its terms of reference to examine private nursing homes/maternity homes and a range of adoption societies but said such a decision could not be made until the current investigation is concluded. At that stage it “may be in a position to make further recommendations”.

Given a major part of its remit is to examine practices in relation to how adoptions were contracted, the second interim reports section on illegal adoption is remarkably lukewarm. In fact, the relevant chapter of the report is titled “False registration of birth” — a rather euphemistic term favoured by government departments. The false registration of birth, which was often facilitated by registered adoption societies, is after all, a serious criminal offence.

The report notes that illegal adoptions cover a “wide variety of situations including actions taken (or not taken) prior to the adoption and illegality in the adoption orders made”.

However, it makes no effort to highlight any of these. Instead, the focus of the section is on illegal birth registrations.

These occurred where the birth was registered in the name of adoptive parents and — crucially, from the State’s perspective — no formal adoption order was ever made.

In short, most of these cases can’t be called illegal adoptions as no formal adoption order was ever granted by the Adoption Board. The State is off the hook.

While the Commission acknowledges that the false registration of a birth is a criminal offence, it speculates that those involved in such practices may have been engaging in a crime for what they thought were the right reasons.

“It is possible that such registrations were carried out for what were perceived to be good reasons (this does not change the fact that it was an offence). Formal legal adoption did not become available in Ireland until 1953.

There is some anecdotal evidence to suggest that, prior to the availability of formal adoption, “adoptive” parents may have falsely registered the birth in the belief that they were conferring legal status on the child.

This narrative, offered without anything other than “anecdotal evidence”, indicates that such activity was done by ordinary, well-meaning couples rather than being facilitated by any other power structure such as a religious order or, indeed, the State.

However, what about the possibility that the opposite of this scenario may also be true? Namely, that such activity may have been facilitated for less than well-meaning reasons?

In December 2017, the Commission published its third interim report. The prime focus of the four-page report was to seek permission to push back the deadline for submitting its final report until February 2019.

However, as with the second interim report, some of the language seemed to seemed to be dampening expectations in terms of what the investigation could achieve.

The key line in the report is the Commission’s belief that it will be “difficult to establish the facts” surrounding the burials of children who died in all of the homes it is investigating.

It noted that that while there are “detailed death records available” in relation to mother and baby homes, there are also “significant gaps” in the information available about the burials of babies who died in a number of the institutions it is examining.

“The Commission is continuing to make inquiries about burials and burial records but it appears that this is an area in which it will be difficult to establish the facts,” stated the report.

Following the publication of the report, Ms Zappone announced other measures which would operate in parallel to the Commission’s work. Most notably, a collaborative forum would be established to support former residents of mother and baby homes. in developing solutions to the issues of concern to them.

One week later, the Government published the findings of the ETG report into the site at Tuam.

As with the second interim report, a very specific element of the report’s findings was leaked to the Irish Times in advance of publication.

This focused on the ETG assertion that it would be difficult to isolate individual remains at Tuam and that the Government should seek to ensure that expectations as to what is possible should be set at “realistic levels”.

However, a full reading of the report revealed other key points of interest in terms of what the State obligations may be in terms of investigating the circumstances of the burials at Tuam.

It outlined five options which the Government could pursue when managing the location.

These range from doing no further investigative work to a full forensic excavation and analysis of all human remains.

It also revealed Ireland may be bound by law to investigate the deaths to the fullest degree possible.

“These include human rights issues around the right of an individual to a respectful and appropriate burial,” said the report.

“There is also the possibility that there may be an obligation under international human rights law, including under the European Convention on Human Rights, arising from the right to respect for family life. This could arguably entitle living family members to know the fate of their relatives.

“There is an obligation on the State, pursuant to the Irish Constitution (Bunreacht na hÉireann) and under human rights law, to fully investigate the deaths so as to vindicate the right to life of those concerned.”

As a result, Ms Zappone has asked Special Rapporteur on Child Protection, Dr Geoffrey Shannon, to examine these issues and to report to her on the matter.

If Mr Shannon finds that these rights exist, then it may influence which of the five options the Government chooses when dealing with the Tuam site, or indeed any of the other institutions where children are known to have died. His report is due next month.

In the meantime, we wait.

It would seem obvious that the fullest possible exhumation and analysis of the remains should be pursued. However, that would commit Government to the same course of action at every other potential site linked to a mother and baby home. This raises all manner of further issues — most notably cost.

In March, Catherine Corless hit out at the Government for focusing “on cost” rather than committing to a full forensic excavation, exhumation, and DNA testing of the remains at Tuam.

She expressed her anger at the “callous and cold voting system” put in place by Galway County Council as part of an independent consultation process on the five options presented by the ETG.

On forms issued by Galway County Council, interested parties were asked indicate their preferred option “by placing an X in the appropriate box” next to one of the five options.

Ms Corless’ intervention came just one month after the Irish Examiner uncovered evidence that children from the Bessborough Mother and Baby Home and another State-funded and accredited former adoption agency in Cork were buried in unmarked graves in a Cork City cemetery as late as 1990.

Tusla, who now hold the records, declined to say whether they had informed the Commission of these deaths before the Irish Examiner revealed them.

Both the Commission and the Department of Children and Youth Affairs have also declined to say whether or not all of the burials found would be investigated.

Whatever the Government decides to do with Tuam is just one part of the picture. The Commission will publish its final report in February of next year.

What it says on adoption will be crucial. It is too big a scandal to be simply tacked onto a report.

The children who died in these institutions can no longer speak for themselves.

However, there are thousands of adoptees out there — many of whom have no idea that there adoptions were illegal or that their identities were falsified. The scale of this scandal and the State’s role in this needs to be fully examined.

It will not simply go away.