ciao naughtybits and welcome to our DT forum!
You don't say how long you'll be in Italy overall but I expect it might be at least a week or even two.
I would agree that renting a car and driving in Italy can be a daunting experience, especially if you end up picking up the car at the airport as soon as your flight lands.
While in Rome, plan on NOT having a car. Once you leave towards Tuscany, then you'll likely need a car - but it depends on WHERE you plan to stay.
If you are planning to stay within a town, then the most convenient way to move about might be the train (and not necessarily the bus, it all depends where you're going).
But if you're planning to stay out in the Tuscan countryside you will definitely need a car. If you aren't staying in a town proper, but at a villa or farmhouse apartment a kilometer or two out of the town, will you be walking or cycling the distance to get to the bus stop? Probably not. Aside from the inconvenience of bus schedules, you do end up eating up time you could use otherwise.
If you feel fine about driving on curvy, hilly roads then you shouldn't have a problem driving in Tuscany. It depends on your own experience driving AND on where you would like to go while in Tuscany, whether you want to stay in the countryside vs. city, etc.... if you give us a better idea of what you've decided so far (for example, do think you'll move around or stay in one area the whole time?) we likely can offer more helpful suggestions.
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