This article revisits the assumption that the welfare delivery state does not fit into the vertical or hierarchical model of political accountability in light of its recent organizational arrangements. Although a distinction in any analytical framework between managerial and political accountability bears some fruit, the replacement of the latter with the former is contestable and misleading. In contrast to the claims that managerial accountability is a technical and neutral exercise in the application of politics-free criteria, and, as such, it more readily fits the complexity of the 21st-century welfare state, this article suggests that the new organizational arrangements of state schools and hospitals indicate that traditional forms of accountability to elected officials have not withered. The process of developing new welfare state organizational arrangements cannot be divorced from fundamental institutional questions about each democracy. By empirically investigating the effects of the introduction of managerialism on democratic accountability in Britain and Germany, the article aims to further our understanding of the link between the managerial and political dimensions of accountability in the welfare delivery state.