The telecom exchange is the point in which all traffic of data and calls are switched over and sent to their locations. They work with a series of cards inside what is known as a DSLAM which are then sent to datacentres. for example, if you are on BT total broadband in the UK then they would most likely be sent to centrals in Ilford. These are more commonly known as nodes.
ISPs may have their own equipment in the exchange to offer better service at a better price. Otherwise you are connected to BT's equipment.
On the horizon Sutton Common Radio tower can be seen.